Endoscopic lung volume reduction in severe emphysema. 
Therapeutic options in severe emphysema are limited.  Endoscopic lung volume reduction (ELVR) refers to bronchoscopically inducing volume loss to improve pulmonary mechanics and compliance, thereby reducing the work of breathing.  Globally, this technique is increasingly used as treatment for advanced emphysema with the aim of obtaining similar functional advantages to surgical lung volume reduction, while reducing risks and costs.  There is a growing body of evidence that certain well-defined subgroups of patients with advanced emphysema benefit from ELVR, provided that a systematic approach is followed and selection criteria are met.  In addition to endobronchial valves, ELVR using endobronchial coils is now available in South Africa.  The high cost of these interventions underscores the need for careful patient selection to best identify those likely to benefit from such procedures.