TABLE 1.
Contraindications for lung volume reduction
| Recommended contraindications for lung volume reduction procedures |
| DLCO or FEV1 <20% predicted# |
| 6MWD <100 m |
| PaCO2 >60 mmHg or PaO2 <45 mmHg at room air or >3 L·min−1 O2 supplementation |
| Frequent exacerbations and/or bronchiectasis or infection (Aspergillus fumigatus, NTM etc.) |
| Other pulmonary disease: ILD, ABPA, SAD or bronchiolitis without emphysema |
| Pulmonary hypertension with invasively measured sPAP >45 mmHg# |
| Immunosuppression or maintenance oral corticosteroids prednisolone >10 mg·day−1 |
| Heart failure with left ventricle ejection fraction <40% |
| Therapeutic anticoagulation which cannot be interrupted |
| Active malignancy or need for follow-up of nodule |
| Life expectancy <3 months |
| Inability to increase physical activity |
| BMI <18 or >35 kg·m−2# |
| Specific for bronchoscopic lung volume reduction with endobronchial valves |
| History of pleurodesis, lobectomy or LVRS |
| Paraseptal emphysema, pleural adhesions |
DLCO: diffusion capacity of the lung for carbon monoxide; FEV1: forced expiratory volume in 1 s; 6MWD: 6-min walk distance; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension; NTM: nontuberculous mycobacteria; ILD: interstitial lung disease; ABPA: allergic bronchopulmonary aspergillosis; SAD: small airway dysfunction; sPAP: systolic pulmonary arterial pressure; BMI: body mass index; LVRS: lung volume reduction surgery. #: no absolute contraindication, case-by-case discussion depending on individual patient characteristics and type of intervention. Reports on interventions in patients with poor lung function or hypercapnia have been published [32, 36–40] and for endobronchial valves experts recommend a cut-off of 50 mmHg for sPAP.