Abstract

Bronchodilators have been described as the pharmacological equivalent of lung volume reduction surgery. The National Emphysema Treatment Trial showed that LVRS achieved significant improvements in exacerbation frequency and time to first exacerbation. The effect on exacerbations could be attributed to a quite modest bronchodilator effect and those patients with the largest post-operative improvement in FEV1 had a significantly longer time to first exacerbation. Indeed, the same mechanical principle in LVRS, i.e. stabilisation of the airways and reduction of air trapping, may explain the reduction of exacerbations observed with tiotropium.