title: [When the throug is reached].
abstract: The only option for a patient suffering from severe chronic obstructive pulmonary disease (COPD) despite fully developed medical therapy inclusive eventually supplemental oxygen is either lung transplantation or lung-volume-reduction surgery (LVRS). Indication for LVRS is based on the results of a large prostective controlled clinical trial and patients are selected for this intervention based on particular functional and radiomorphologic criteria. We report a patient with far advanced COPD, no longer able to walk to the toilette without support. Based on clinical reasoning and our experience with other unique cases the patient underwent unilateral LVRS despite a lack of scientific evidence that she might profit from this intervention. Luckily, the perioperative course was uneventful and she experienced an impressive subjective and objective improvement. This case illustrates, that in desperate situations it may be necessary to reach a therapeutic decision outside scientifically based evidence.
authors.affiliation: Klinik für Pneumologie, Departement Innere Medizin, Universitätsspital Zürich, Zürich.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Turk
authors.forename: Erich W
authors.initials: EW
authors.lastname: Russi
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D002245:Carbon Dioxide / Q000097:blood; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen