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able to undergo the procedure, it is sometimes necessary to postpone it because a patient might not be able to tolerate the stress of anaesthesia. 10 Cost-effectiveness ELVR treatment methods are expensive. Cost estimates following an analysis were: valve method ($12,943); coil method ($11,328); and volume reduction surgery ($2444). 18 These calculations do not include the costs associated with the management of complications and hospitalisation. Depending on agreements with health care systems, the cost of the Chartis catheter and delivery system for a single procedure can vary from $9185 to $10,300. However, total costs for one year of coil treatments were approximately $53,521 and $5912 for follow-up patients. 19 In a landmark study (REVOLENS), the initial cost of coil therapy seemed very high, therefore, large-scale studies are required to better determine this method’s long-term cost and efficacy. 19 Conclusions Increasing ELVR treatment modalities have expanded the treatment spectrum for COPD patients with severe emphysema. In a group of patients with severe COPD, who were potential lung transplant candidates, positive results were obtained with ELVR treatment, indicating that ELVR treatment can act as a bridge until the time of transplantation. 20 The most important reason for increasing treatment efficacy is correct patient selection. Although the EBV and coil treatments are the most commonly used methods, there is emerging positive evidence for other methods, such as thermal vapour ablation, bio-lung volume reduction, and targeted lung denervation. Autologous blood application will be performed much more frequently in the near future due to its low cost and easy applicability. 21 Most recently, a newly designed device known as the ‘reverser’, which is similar to the coil structure, was tested in pigs, and positive results were obtained. 22 The creation of treatment algorithms, research on the long-term effects of these methods, prevention and control of complications, and appropriate development of these methods are the most important issues ahead. follow-up. However, prophylactic antibiotics are frequently used by the bronchoscopist due to the high risk of COPD exacerbation and pneumonia. There is no general consensus on the best application of prophylactic antibiotics. Short-term steroid administration and stress ulcer prophylaxis are generally recommended to reduce the post-treatment acute inflammatory response. 17 Use of anaesthesia during the procedure The EBV procedure is generally performed with mild sedation, and the coil procedure is performed with general anaesthesia in the operating room. Although patients are generally References: 1 Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2017. www.goldcopd. org/ (accessed July 2019). 2 Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med 2013;369:448–57. 3 Holloway RA, Donnelly LE. Immunopathogenesis of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2013;19:95–102 4 Marchetti N, Criner GJ. Surgical approaches to treating emphysema: Lung volume reduction surgery, bullectomy, and lung transplantation. 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