Lung volume reduction has led to substantial benefits for well-selected patients with advanced emphysema associated with lung hyperinflation and with persistent disabling symptoms despite optimised medical therapy. Recently, following US Food and Drug Administration (FDA) and European Medicines Agency approval, endobronchial valve (EBV) treatment has largely replaced lung volume reduction surgery (LVRS) as the preferred initial approach to volume reduction. EBVs induce volume reduction through partial or complete lobar atelectasis, without the burden of chest wall incision and lung resection [1, 2]. While several randomised trials have reported clinically important improvements in lung function, symptoms and functional performance, but >34% rate of pneumothorax following EBV [3–5], no randomised clinical trial has directly compared the benefits and risks of LVRS to EBVs until today.