Five-Year Lung Volume Reduction Surgery Study Shows Durable Clinical and Significant Physiologic Improvements in End-Stage Emphysema Patients

Released June 2001

In one of the first five-year studies to be completed on lung volume reduction surgery (LVRS) in both lungs, researchers studied 26 patients with end-stage emphysema who received the procedure. They showed that nine individuals had durable clinical and significant physiologic improvement after 3 years, seven after 4 years, and two after 5 years. The study appears in the June issue of the American Journal of Respiratory and Critical Care Medicine.

Arthur F. Gelb, M.D., of the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, University of California, Los Angeles, along with four associates, said their research had very strict objective outcome criteria directed at the elderly patients. Since the participants’ average age was 67, an estimated 60 percent of the seriously ill study patients would have died from respiratory failure within one year had they not had the surgery. In this investigation, all patients prior to their operation could walk less than 100 yards and had exhausted the best medical therapy available. Eighteen were on full or partial oxygen therapy. The 18 men and eight women participants had a smoking history of 52 pack years (meaning they had smoked at least 20 cigarettes per day, every day, per year). All participants had stopped smoking from 3 years to 6 months prior to their surgery.

LVRS is usually performed on patients with end-stage emphysema who are at high risk of dying from their disease. Emphysema is caused by chronic bronchitis, mostly from smoking, and it can grow worse with advancing age. Lungs damaged by changes caused by emphysema gradually lose their elasticity, becoming floppy and overexpanded, like a spent rubber band. Consequently, such patients have difficulty moving air in and out of the lungs. LVRS removes the diseased portions of the lung which leads to improvement in the functioning of the remaining lung tissue. In this study, approximately 20 to 30 percent of each lung was removed.

Specifically, LVRS is designed to: increase expiratory airflow from the lung, improve exercise capacity, upgrade respiratory muscle strength, aid elastic recoil, improve partial pressure (tension) of carbon dioxide in the arteries, assist in the ventilatory muscle recruitment patten, and reduce serious breathlessness (dyspnea).

“The improvement in dyspnea and exercise tolerance following LVRS best correlates with the reduction in hyperinflation and an increase in transdiaphragmatic pressure due to repositioning of the diaphragm with recruitment of inspiratory muscles and increased neuro-mechanical coupling,” said Dr. Gelb. “All this is often irrespective of any changes in the lung function test called forced expiratory volume at 1 second.”

Eleven patients survived for 5 years. The other deaths were all from respiratory failure. According to the authors, out of 26 patients, there were 23 significant responders at 6 months, 19 at 1 year, 12 at 2 years, nine at 3 years, seven at 4 years, and two at 5 years.

American Thoracic Society    http://www.thoracic.org