Lung decompression should be an important treatment for those patients with severe emphysema who have failed to improve with medical therapy and whose symptoms have not improved. Lung decompression surgery can eliminate the need for lung transplantation and lifelong immunosuppression for some patients, and can be used as a bridge procedure to lung transplantation in the absence of a donor for another group of patients. Before having lung volume reduction surgery, one must stop smoking for at least 3 to 6 months. Lung decompression surgery, in short, is the surgical removal of over-inflated, non-functional lung tissue, reducing the size of the lung so that the previously squeezed normal lung tissue is available and can function adequately, thereby improving the patient’s respiratory function and their quality of life. What kind of patients are suitable for lung reduction surgery? Patients must have severely reduced lung function, severely limited mobility, and ineffective conservative treatment. Because of the relatively high risk of this surgery, strict control of the indications for surgery is the key to its success. Indications for surgery include: a clear clinical diagnosis of severe emphysema; lung function consistent with obstructive ventilatory dysfunction and reduced diffusion function; hyperinflation and expansion of the lung with a heterogeneous distribution on chest radiographs and CT, with a clear area of severe disease (target area) on CT and nuclear ventilation/perfusion scans; and age 65 to 75 years. Patients with the following conditions are not suitable for pulmonary decompression surgery: severe diffuse emphysema; age >75 years; significantly elevated pulmonary artery pressure; severe bronchitis, bronchiectasis or asthma; severe coronary artery disease or other significant organ disorders; excessive obesity or excessive wasting; those requiring preoperative ventilator maintenance breathing; extensive thoracic adhesions, thoracic deformities; long-term hormone therapy; and current smokers. Clinical practice has confirmed that most patients can have significant improvement in symptoms, exercise capacity, and lung function indicators after lung reduction surgery, and in the words of patients’ families, “it’s like a new person!” This effect lasts for more than 4 years, in other words, the clock is turned back by at least 4 years! Pulmonary decompression can be performed by open-chest, small incision, or thoracoscopic surgery, either unilaterally or bilaterally at the same time, depending on the patient’s condition. Currently, it is believed that bilateral lung reduction surgery through a median sternotomy or thoracoscopy is more effective than unilateral surgery.