Lung Volume Reduction Surgery (LVRS) is a surgical option for select patients with severe emphysema-predominant COPD, particularly those with upper-lobe–predominant disease and low exercise capacity. The procedure involves removing damaged, non-functioning portions of the lung to allow the healthier lung tissue to expand and function more effectively. LVRS can improve lung function, exercise tolerance, and quality of life, and has been shown to provide a survival benefit in carefully selected patients. However, it carries significant surgical risks and is typically considered only after optimizing medical therapy. Candidates must undergo thorough evaluation, including imaging and pulmonary rehab, to determine eligibility.