Yes. A number of years ago we used to do lung volume reduction surgery for the management of COPD. This started to become quite common and was probably overdone, which resulted in an increased morbidity and mortality associated with the procedure. As a consequence, it started to be done much less. And even in some states, it's not really allowed to be done within the public hospitals. So I think the evidence that it's of significant value is limited, but having said that there are some people that do benefit from lung volume reduction surgery.
Having said that, these days there is certainly evidence in the insertion of endobronchial valves, endobronchially obviously. It's a non-surgical procedure where one hopefully reduces lung volume in certain areas of the lungs, which then causes those areas to deflate, which reduces the hyperinflation associated with COPD and we certainly know that hyperinflation is a significant cause of symptoms in COPD, because it is probably one of the things that reduces patients' exercise tolerance. And if we can reduce that, then it certainly is of benefit to them. So I think from a pure surgery as in knife-to-skin perspective, it's very limited. But there are some newer techniques that have been tried that are hopefully going to help symptomatically, without have the morbidity and mortality that was associated with lung volume reduction surgery.
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