Which of the following are relative contraindications for surgical management of emphysema?

B. Bullae occupying less than one third of a hemithorax on plain chest radiography.

C. Elevated room air PCO 2

E. FEV 1 less than 35% of predicted value.

DISCUSSION: Relative contraindications to operation for bullous emphysema include patients with carbon dioxide retention, FEV 1 less than 35% of predicted value, small bullae that occupy less than one third of a hemithorax, and “blue bloaters,” who are prone to the sequelae of chronic bronchitis. Patients who have primarily emphysema (“pink puffers”) and rapidly progressive dyspnea are usually good candidates for operation.