Effect of removal of bullae on airway conductance and conductance volume ratios

Rogers, Robert M.; DuBois, Arthur B.; Blakemore, William S.

doi:10.1172/jci105939

Cited by 53 publications

(19 citation statements)

References 12 publications

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“…The resulting de crease in lung volume and attending loss of elastic recoil leads to relaxation of peribronchial tension, diminution in airways diameter and thus an ob structive syndrome affecting the non-diseased portions of the lung. Only in this way can one explain marked diminution of airflow and great increase of airways resistance that is relieved by surgical extripation, as shown by our case (table 1) and elsewhere [18]. The diameters of the many bronchial com munications between bullae and normal lung are also decreased, resulting in trapping of gas within the bullae that is not seen at surgery or autopsy.…”

supporting

confidence: 54%

Surgery for Bullous Emphysema

FitzGerald¹,

Keelan²,

Gaensler³

1973

Respiration

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A 60-year-old man was observed for 7 years with progressive bullous emphysema that eventually rendered his right lung functionless and resulted in severe dyspnea. Thoracotomy revealed typical periacinar (paraseptal) emphysema. Excision and plication of bullae resulted in prompt relief of symptoms and return of function which were sustained during the next 5 years. The progressive course and recovery were documented by serial clinical, radiographic, physiologic and regional lung function studies. The natural evolution of bullous lung disease is reviewed as are the concomitant physiologic abnormalities and indications for surgerys

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supporting

confidence: 54%

Surgery for Bullous Emphysema

FitzGerald¹,

Keelan²,

Gaensler³

1973

Respiration

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“…The resultant improvement in lung function increases expiratory gas flow, exercise tolerance, and possibly the clearance of respiratory secretions (22)(23)(24). Enhanced removal of these secretions may reduce the burden of airway pathogens, augment pulmonary immune defense mechanisms, and thus reduce the risk for infections, which are responsible for most exacerbations in persons with severe COPD.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Lung Volume Reduction Surgery on Chronic Obstructive Pulmonary Disease Exacerbations

Washko

Fan

Ramsey

et al. 2008

Am J Respir Crit Care Med

101

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Rationale: Lung volume reduction surgery (LVRS) has been demonstrated to provide a functional and mortality benefit to a select group of subjects with chronic obstructive pulmonary disease (COPD). The effect of LVRS on COPD exacerbations has not been as extensively studied, and whether improvement in postoperative lung function alters the risk of disease exacerbations is not known. Objectives: To examine the effect, and mechanism of potential benefit, of LVRS on COPD exacerbations by comparing the medical and surgical cohorts of the National Emphysema Treatment Trial (NETT). Methods: A COPD exacerbation was defined using Centers for Medicare and Medicaid Services data and International Classification of Diseases, Ninth Revision, discharge diagnosis. Measurements and Main Results: There was no difference in exacerbation rate or time to first exacerbation between the medical and surgical cohorts during the year before study randomization (P 5 0.58 and 0.85, respectively). Postrandomization, the surgical cohort experienced an approximate 30% reduction in exacerbation frequency (P 5 0.0005). This effect was greatest in those subjects with the largest postoperative improvement in FEV 1 (P 5 0.04) when controlling for changes in other spirometric measures of lung function, lung capacities, and room air arterial blood gas tensions. Finally, LVRS increased the time to first exacerbation in both those subjects with and those without a prior history of exacerbations (P 5 0.0002 and P , 0.0001, respectively). Conclusions: LVRS reduces the frequency of COPD exacerbations and increases the time to first exacerbation. One explanation for this benefit may be the postoperative improvement in lung function. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606). Keywords: COPD; LVRS; exacerbationChronic obstructive pulmonary disease (COPD) is responsible for an estimated 176 million hospital bed days per year in the United States and an annual loss of almost 60 million workdays (1). A significant portion of the health care costs incurred by COPD is due to acute exacerbations. Although the mainstays of medical treatment and prevention include inhaled long-acting bronchodilators and corticosteroids, their efficacy in this regard is debated (2-4). The basis for their presumed beneficial effect is a combination of their bronchodilating and antiinflammatory properties, effects that may offset the increased risk of exacerbations found with declining lung function (5-12). Given this, mechanical interventions that improve function, such as lung volume reduction surgery (LVRS), may reduce the frequency of acute exacerbations.Results from the National Emphysema Treatment Trial (NETT) suggest that there is a subset of subjects with COPD who obtain functional, quality-of-life, and mortality benefits from LVRS (13). Although still statistically significant at 3 years postrandomization, these postsurgical improvements in lung function for LVRS patients had attenuated and were approaching measurements made in the medical cohort. ...

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“…This has certainly been shown to be true following focal bullectomies in which normal lung tissue is compressed (5)(6)(7)(8) and has been proposed as the primary mechanism for improvement in LVRS.…”

mentioning

confidence: 95%