Key Points

1. The airway by pass and bronchoscopic lung volume reduction are one step beyond on their way to clinical application.
2. Lung morphology (heterogeneity) and collateral ventilation are important to select the most appropriate procedure.
3. The airway by pass allows bypassing the small obstructed airways.
4. The creation of artificial communications between lung parenchyma and segmental bronchi would facilitate lung deflation taking advantage of collateral ventilation.
5. Bronchoscopic lung volume reduction with one – way valves facilitates deflation of the most over inflated emphysematous parts of the lung.
6. One way valves are designed to control and redirect airflow by preventing air entering the target lung but allowing air and mucous to exit.

Emphysema is a debilitating lung disease continuing to be a major source of morbidity and mortality in the developed countries. Estimates suggest that as many as two million people are affected in the United States; many of them develop severe dyspnoea and subsequent deterioration in quality of life, with associated costs of US $ 2.5 billion annually, and nearly 17.000 deaths each year [1],[2],[3],[4],[5]. Medical therapy is the mainstay of therapy and primarily consists of smoking cessation, pulmonary rehabilitation, administration of bronchodilators and, when indicated, steroids and supplemental oxygen.