Lung volume reduction surgery as a treatment for emphysema may be considered medically necessary in patients who meet all of the following criteriaa:
Predominantly upper-lobe emphysema with hyperinflation and heterogeneity (ie, target areas for removal)
Forced expiratory volume in 1 second (FEV1):
For patients who are younger than 70 years of age, FEV1 must be no more than 45% of the predicted value.
For patients who are 70 years of age or older, FEV1 must be no more than 45% of the predicted value and 15% or more of the predicted value.
Marked restriction in activities of daily living, despite maximal medical therapy
Age younger than 75 years
Acceptable nutrition status (ie, 70% to 130% of ideal body weight)
Ability to participate in a vigorous pulmonary rehabilitation program
No coexisting major medical problems that would significantly increase operative risk
Willingness to undertake the risk of morbidity and mortality associated with lung volume reduction surgery
Abstinence from cigarette smoking for at least 4 months.
Lung volume reduction surgery is considered investigational in all other patients.
a Patient selection criteria are based on the National Emphysema Treatment Trial.
