Parameter | Indications | Contraindications |
Clinical | Age <75 years | Age ≥75 years |
Ex-smoker (>6 months) | Current smoking |
Clinical picture consistent with emphysema | Surgical constraints (eg, previous thoracic procedure, pleurodesis, chest wall deformity) |
Dyspnea despite maximal medical therapy and pulmonary rehabilitation | Pulmonary hypertension (PA systolic >45 mmHg, PA mean >35 mmHg) |
Comorbid illness* | | Clinically significant bronchiectasis |
| Clinically significant coronary heart disease |
| Heart failure with an ejection fraction <45 percent |
| Uncontrolled hypertension |
| Obesity¶ |
Physiology | FEV1 after bronchodilator <45 percent predicted | FEV1 ≤20 percent predicted with either DLCO ≤20 percent predicted or homogeneous emphysema |
Hyperinflation (TLC >100 percent predicted, RV >150 percent) | PaO2 ≤45 mmHg on room air |
Post rehabilitation 6-minute walk distance >140 meters | PaCO2 ≥60 mmHg |
Low post rehabilitation maximal achieved cycle ergometry wattsΔ | |
Imaging | Chest radiograph - hyperinflation | |
HRCT confirming severe emphysema, ideally with upper lobe predominance | Homogeneous emphysema with FEV1 ≤20 percent predicted |
| Significant pleural or interstitial changes on HRCT |
| Nonupper lobe predominant emphysema and high post rehabilitation maximal achieved cycle ergometry watts◊ |