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| |  Significant Improvement Seen In Emphysema Patients Undergoing Lung Reduction Surgery CHICAGO, IL -- December 14, 1999 -- Seven of 26 elderly patients with emphysema who faced almost certain death from respiratory failure, were alive with much improved lung function four years after undergoing lung volume reduction surgery (LVRS), according to a study published in the December issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
"The results indicate significant clinical and physiologic improvement in nine patients at three years and seven at four years following LVRS," said Arthur F. Gelb, M.D., FCCP, of the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, University of California at Los Angeles, who, with five associates, performed the study. Emphysema is a disease in which the tiny air sacs at the end of very small air passages in the lungs become damaged, usually from cigarette smoking. The damaged alveoli can cause severe shortness of breath. Serious cases lead to respiratory and heart failure. An estimated in 2 million adults in the U.S., suffer from the problem. Along with other forms of chronic pulmonary disease, it accounts for 90,000 deaths annually. The 26 study patients, who averaged age 67, suffered from end-stage emphysema. They were able to walk less than 100 yards and 18 required full or part-time oxygen supplementation. All suffered markedly from very difficult, labored breathing. Each patient had exhausted all medical therapy for their disease including antibiotics, aerosol and systemic bronchodilators and corticosteroids, plus repeated attempts at physical conditioning, according to the researchers. Lung volume reduction surgery, reintroduced in 1992, is based on the premise that patients with severe emphysema have lungs that have become too large for their chests. Removing lung tissue reduces the volume of the hyperinflated lung, leading to improvement in function. Surgery is usually carried out on both lungs. In this study, approximately 20 to 30 percent of both lungs were removed. The average survival time for the 16 non-long-term responders was almost 30 months. One patient died shortly after surgery. "Of all preoperative lung tests, only forced vital capacity and vital capacity was able to identify the nine patients with significant physiologic improvement at three years post-surgery," said Dr. Gelb. Vital capacity, used to determine the status of lung tissue, is a test designed to determine the maximum amount of air that can be exhaled after maximum inhalation. Also in the December issue of CHEST, the National Emphysema Trial Group describe their upcoming 4-1/2 year multicenter, randomized clinical trial of medical therapy for severe disease versus medical therapy plus LVRS. The goal of the trial is to recruit 2500 patients, with 30 percent expected to be women. The investigators' aim is to enroll patients with severe emphysema who have no existing conditions that would prevent them from being randomly assigned to one of the two treatment groups. The clinical trial's primary outcome measure will be survival. Additional outcomes to be assessed include maximum exercise capacity, pulmonary function, oxygen requirements, distance walked in six minutes, quality of life, respiratory symptoms, and health-care utilization and costs. CHEST is published by the American College of Chest Physicians which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
Related Link: CHEST.
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