LVRS Versus BLVR in Patients With Homogenous Emphysema, CLUB-HE Trial

Inclusion Criteria: * COPD III-IV * Age ≥ 18 years * FEV1 \< 50% predicted after bronchodilatation * Significant hyperinflation (TLC \>100% predicted, RV \> 200% predicted, RV/TLC \> 60%) * Non-smoker or ex-smoker for \> 3 months (documented by cotinine testing) * 6 MWT \>150 m and ≤ 450m * MRC dyspnea score \> 3 * Homogenous emphysema as assessed by HR-CT (\< 15% difference in emphysema destruction score between target lobe and ipsilateral lobe) \[16, 17\] * Uni- or bilateral collateral ventilation (CV) negative result assessed fissure completeness\>95% in QCT and confirmed by a bronchoscopic procedure (Chartis©) * Optimal medical therapy for \> 3months, sufficient rehabilitation status with no need for further training/rehabilitation or rehabilitation within 6 months prior to intervention. * Body Mass Index (BMI) \> 18, but \< 35 kg/m2 * Daily dose of prednisone ≤ 10mg Exclusion Criteria: * Contraindication against either LVRS or BLVR and/or to surgery and bronchoscopy in general * Major comorbidities limiting survival * Age ≥ 80 years * Nicotine abuse within 3 months (documented by cotinine testing) * Predominance of either left or right lung of \>70% in perfusion SPECT scintigraphy * FEV1 and/or DLCO \<20% predicted (post bronchodilatation) * Untreated Hypoxemia (PaO2 \< 50 mmHg) * Untreated Hypercapnia (PaCO2 \> 50 mmHg) * Significant pulmonary fibrosis or bronchiectasis * Destroyed/vanished lung on HR-CT * Previous chest surgery or bronchoscopic interventions * Pulmonary hypertension (sPAP \> 35 mmHg) * Active waiting list for lung transplantation * Patient is not able to understand and willing to sign a written informed consent document. * Pregnancy