Novel Interventional and Surgical Therapies in Chronic Obstructive Pulmonary Disease

Abstract: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with its global prevalence projected to increase substantially by 2050, making its management one of the greatest challenges in respiratory medicine. Although pharmacological and nonpharmacological therapies remain the cornerstone of care, many patients continue to experience debilitating breathlessness, recurrent exacerbations, and impaired quality of life despite optimal medical treatment. Advances in interventional technology, imaging, patient selection, and anesthetic safety have transformed the therapeutic landscape, expanding the role of bronchoscopic and surgical interventions in the management of selected patients with COPD. These therapies aim to address the structural and pathophysiological consequences of disease that cannot be adequately treated with conventional medical therapy alone. Over the past three decades, lung volume reduction (LVR) has been extensively investigated and is now an established treatment option for appropriately selected patients with advanced emphysema. Both surgical and bronchoscopic LVR techniques have demonstrated improvements in lung function, exercise capacity, symptoms, and quality of life in carefully selected populations. Beyond LVR, a new generation of bronchoscopic therapies is emerging to target other COPD phenotypes and unmet clinical needs, including interventions designed to reduce exacerbation frequency, modify airway pathology, and improve symptom control. As the range of available treatment options continues to expand, multidisciplinary assessment and precision phenotyping are becoming increasingly important to identify the most appropriate intervention for each patient. This review provides an overview of the current evidence supporting established surgical and bronchoscopic LVR procedures and examines emerging bronchoscopic therapies for COPD. We discuss patient selection, procedural considerations, clinical outcomes, and future directions, highlighting the evolving role of interventional therapies within a personalized, multidisciplinary approach to COPD management.