Emphysematous changes are common in the general population, occasionally resulting in pneumothoraces; a significant number of these patients require surgical intervention. Many procedures have been performed to alleviate the dyspnoea in the severely emphysmatosy patient, some with beneficial effects but others without any proven beneficial outcome (Table 1). Recently, laser and videoscopic technology have been used to ablate small bullae [1-3]. In 1959, Brantigan et al. [4], from the University of Maryland, reported on the surgical management of diffuse emphysema. "In patients with distended lungs caused by severe COPD, the normal outward circumferential pull on the bronchioles had been lost, causing their collapse during expiration. Reducing overall lung volume, by means of multiple wedge excisions or plications, would restore the elastic pull on the small airways and reduce expiratory airway obstruction" [4].
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