The current convention is for bilateral one-stage lung volume reduction surgery. Unilateral surgery results in a symptomatic improvement in most patients. A staged approach to the second lung may reduce the risk of surgery and lead to a slower decline in physiologic improvement. The timing of the second operation can be influenced by the patient and the surgeon. The surgeon may be anxious to avoid the patient becoming inoperable because of excessive physiological decline or the patient succumbing to the inherent mortal risk of emphysema. The patient may be the best arbiter. The operation should be intended to improve his or her subjective assessment of health status; therefore, this parameter ultimately should determine the surgical schedule.