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Lung Reduction Surgery Proves Beneficial in Long Term New Five-Year Study Data Shows Improved Lung Function and Quality of Life NORTHBROOK, IL, April 8, 2003 Lung volume reduction surgery (LVRS) can have long-term benefits for patients with severe emphysema, says a study published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP). The study found that throughout the five years after LVRS, patients showed significant improvements in dyspnea (shortness of breath), lung function, and quality of life while also reporting a high level of satisfaction with the surgery. "Nearly half of all patients with severe emphysema will die within five years of diagnosis, and in these years, quality of life will be compromised by constant shortness of breath and the inability to do everyday tasks," said lead author Roger D. Yusen, MD, MPH, Washington University School of Medicine, St. Louis, MO. "Ours is the largest long-term study showing LVRS may actually change the natural progression of the disease, improving lung function and quality of life even five years after surgery." The study, conducted at Barnes-Jewish Hospital, St. Louis, MO, evaluated the long-term effects of LVRS on survival, dyspnea, lung function, quality of life, oxygen levels, exercise capacity and patient satisfaction in patients with severe emphysema. From 1993-1998, 200 patients underwent bilateral LVRS, the procedure of removing diseased lung tissue to allow increased function in the remainder of the lung, and were followed through a five-year study period. Annual survival through five years after surgery was 93 percent, 88 percent, 83 percent, 74 percent, and 63 percent, respectively. Researchers assessed surviving patients using clinical tests and surveys at follow-up time points of six months, three years, and five years after surgery. Survey results revealed that dyspnea scores improved in 81 percent of respondents in the first six months. At three and five years after surgery, respectively, 82 percent and 74 percent of the respondents described dyspnea that was better or no worse than dyspnea prior to surgery. At six months, three years, and five years after surgery, 98 percent, 94 percent, and 91 percent of respondents showed significant improvement in general health-related quality of life as measured by patients' perceived physical functioning. Clinical lung function tests showed nearly all patients had improved lung function at six months, while 72 percent and 58 percent sustained improvement at the three and five year intervals, respectively. Patients having LVRS also increased exercise capacity and used significantly less oxygen following surgery. Furthermore, survey results indicated that 98 percent, 95 percent, and 86 percent of respondents at the respective follow-up periods had a good to excellent rating in relation to patient satisfaction with the overall surgery. "The results of this study are long-awaited and quite impressive. Previous LVRS studies publishing long-term data pale by comparison," said Arthur F. Gelb, MD, FCCP, Clinical Professor of Medicine, UCLA School of Medicine, and author of the corresponding editorial. "The findings in this study should help to reinstate Medicare reimbursement for LVRS in patients with severe emphysema with good surgical potential in whom there are no therapeutic alternatives." Patients selected for the study were former cigarette smokers with disabling dyspnea resulting from emphysema. All patients had physiologic characteristics of airflow obstruction, air trapping and thoracic hyperinflation, and impairment of alveolar gas exchange. Prior to surgery, patients' baseline scores for dyspnea, quality of life and lung function were determined and compared with follow-up data. "Severe emphysema is a chronic and often fatal illness that has a limited number of effective treatments," said Udaya B. S. Prakash, MD, FCCP, President of the American College of Chest Physicians. "LVRS may be an additional therapy that significantly impacts patients with emphysema by helping them live longer and better." CHEST is a peer-reviewed journal published by the ACCP. It is available on line each month at www.chestjournal.org . ACCP represents more than 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. Contact: Jennifer Stawarz Liza Morris
Source: American College of Chest Physicians (ACCP) 8-Apr-03 |