Lung volume reduction surgery versus conservative treatment in severe emphysema

Abstract

Lung volume reduction surgery (LVRS) has been proposed for patients with severe emphysema to improve dyspnoea and pulmonary function. It is unknown, however, whether prognosis and pulmonary function in these patients can be improved compared to conservative treatment.The effect of LVRS and conservative therapy were compared prospectively in 57 patients with emphysema, who fulfilled the standard criteria for LVRS. The patients were divided into two groups according to their own decision. Patients in group 1 (n=29, eight females, meanSEM 58.81.7 yrs, forced expiratory volume in one second (FEV1) 27.61.3% of the predicted value) underwent LVRS. Patients in group 2 (n=28, five females, 58.51.8 yrs, FEV1 30.81.4% pred) preferred to postpone LVRS. There were no significant differences in lung function between the two groups at baseline; however, there was a tendency towards better functional status in the control group. The control group had a better modified Medical Research Council (MMRC) dyspnea score (3.10.15 versus 3.50.1, p<0.04).Model-based comparisons were used to estimate the differences between the two groups over 18 months. Significant improvements were observed in the LVRS group compared to the control group in FEV1, total lung capacity (TLC), Residual volume (RV), MMRC dyspnea score and 6-min walking distance on all follow up visits. The estimated difference in FEV1 was 33% (95% confidence interval 13±58%; p>0.0001), in TLC 12.9% (7.9±18.8%; p>0.0001), in RV 60.9% 32.6±89.2%; p>0.0001), in 6-min walking distance 230 m (138±322 m; p<0.002) and in MMRC dyspnoea score 1.17 (0.79±1.55; p<0.0001).In conclusion, lung volume reduction surgery is more effective than conservative treatment for the improvement of dyspnoea, lung function and exercise capacity in selected patients with severe emphysema.

Model-Based versus Clinical Prediction of the Spirometric Response to Lung Volume Reduction Surgery

“…The results of LVRS in the validation cohort compare favorably with that reported from other centers [5, 6, 7, 8, 9]. All 60 patients in this consecutive series survived LVRS by more than 6 months, and a major improvement in dyspnea and lung function was achieved with a median increase in FEV 1 and FVC of 41 and 29%, respectively (table 1).…”

“…Experience from case series [1, 2, 3, 4]and data from randomized, controlled trials [5, 6, 7, 8, 9]including the National Emphysema Treatment Trial (NETT) demonstrate that lung volume reduction surgery (LVRS) may improve symptoms, lung function, and exercise capacity in selected patients with advanced emphysema. Yet, the amount of functional improvement achieved by LVRS as well as the perioperative mortality have varied among the study patients.…”

Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV₁

“…Surgical lung volume reduction (sLVR) has been shown to improve lung function and quality of life in palliative care as well as in patients waiting for lung transplantation [1,2,3,4]. Nevertheless, the procedure has relevant risks, and not all patients are suitable to undergo sLVR.…”

Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease

“…At present, it is recognised that these tests add prognostic information useful to the staging of patients with chronic obstructive pulmonary disease (COPD) [2,3], primary pulmonary hypertension [4] and heart failure [5]. Timed walking tests have been shown to be sensitive to changes after interventions such as inhaled bronchodilators [6], volume reduction surgery [7,8] and pulmonary rehabilitation [9,10]. The 6-min walking test (6MWT), for example, is currently used in y80% of rehabilitation programmes in the USA [11].…”