An 84-year-old man with end-stage emphysema was hospitalised on two occasions because of an episode of severe COPD exacerbation, each time successfully treated in a classical pharmacological manner. Further analysis of a high-resolution CT chest scan revealed very pronounced destruction of the lung parenchyma in the left lower lobe. Moreover, the degree of destruction in the left lung was of a highly heterogeneous nature and fissure analysis revealed a complete left major fissure. After carefully weighing up the costs against the benefits, two one-way valves of different sizes were implanted in the orifices of the left lower lobe using video bronchoscopy. This intervention had a very satisfactory outcome with positive changes in the lung function parameters, imaging studies and quality of life. The inevitable placement in a nursing home could consequently be postponed and, at follow-up one year later, no exacerbation or pneumonia had developed since the intervention.