Lung transplantation and COPD

Historically, a variety of surgical approaches have been attempted to correct the underlying pathophysiology and/or to alleviate the troublesome symptoms, especially dyspnea, in patients with chronic obstructive pulmonary disease (COPD) (1,2). By 1970, the operations already included costochondrectomy, thoracoplasty, phrenic nerve interruption, pneumoperitoneum, glomectomy, partial pneumectomy, and whole organ transplantation. In spite of initial enthusiasm for many of these procedures, however, the results were ultimately disappointing. In a commentary on the operations in 1972, Laforet, humorously and perhaps cynically, opined, “The alleged benefits of these maneuvers were frequently lost on patients whose worsened dyspnea left them little energy to debate with their surgeon” (1). But, contemplating the role of transplantation, he also predicted that “the best surgical solution for the patient with crippling and potentially lethal COLD [chronic obstructive lung disease] would be to start from scratch with a new set of lungs.”