Comparison of Lung Volume Reduction Surgery and Physical Training on Health Status and Physiologic Outcomes

Hillerdal, Gunnar; Löfdahl, Claes-Göran; Ström, Kerstin; Skoogh, Bengt-Eric; Jorfeldt, L.; Nilsson, Folke; Forslund-Stiby, Dycke; Ranstam, Jonas; Gyllstedt, Erik

doi:10.1378/chest.128.5.3489

Cited by 40 publications

(21 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The shortness of breath, poor exercise tolerance and impaired health status will occur on the final stage of emphysema [1-3]. Thus far, the conservative medical therapies (antibiotics, bronchodilators, systemic corticosteroids, home oxygen therapy, pulmonary rehabilitation) still remain to be symptomatic treatment rather than always due to failure to improve elastic recoil of lung issue [2-5]. Lung volume reduction surgery(LVRS), which was initially introduced in 1957 by Brantigan [6] and developed by Cooper in 1993 [7], resects diseased and non-function pulmonary issue in order to ameliorate lung function, exercise capacity and health status, by(1) increasing pulmonary elastic recoil, therefore increasing expiratory airflow rates, (2) reducing the degree of hyperinflation, therefore improving mechanics of diaphragm and chest wall, (3) reducing heterogeneity, (4)increasing work of breathing, and improving of alveolar gas exchange [8].…”

Section: Introductionmentioning

confidence: 99%

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Huang

Wang

Deng

et al. 2011

J Cardiothorac Surg

View full text Add to dashboard Cite

ObjectivesWe aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).MethodsEight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.ResultsOdds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.ConclusionsLVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.

show abstract

Section: Introductionmentioning

confidence: 99%

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Huang

Wang

Deng

et al. 2011

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…However, it tends to be used as a general descriptor of HRQoL in cross-sectional surveys [6][7][8][9] or for concurrent validation of other instruments. 10 Only a few studies have attempted to use the SF-36 to compare the efficacy of different treatments and interventions [10][11][12][13] or to describe the decline in quality of life associated with COPD and chronic respiratory symptoms. 14,15 The SF-36 tends to have good construct validity in that it correlates well with objective assessments of health status and other quality-oflife measurements, 6,10 but it does not correlate well with lung function tests.…”

mentioning

confidence: 99%

Predictive validity of short-form health survey [36 items] scales for chronic obstructive pulmonary disease exacerbation

et al. 2008

View full text Add to dashboard Cite

“…In a previous study on AAT deficiency patients (n = 6), ELVR resulted in a mean FEV 1 increase of 265 ml measured from baseline to the last available data 2-12 months later [18]. After LVRS, a mean FEV 1 increase of 140 ml 1 year after surgery has been reported [9]. Thus, our results on patients with AAT deficiency compare favorably with those of several other studies in which baseline values for FEV 1 were within similar ranges.…”

Section: Discussionmentioning

confidence: 99%

“…In the mid-1990s, the method was reintroduced with improved techniques [7]. Randomized studies, such as the large NETT (National Emphysema Treatment Trial) in the United States including 1,218 patients [8] as well as a Swedish study [9], clearly demonstrated that the operation can significantly improve lung function and working capacity, and even reduce mortality in a subset of patients [10]. …”

Section: Introductionmentioning

confidence: 99%

One- to Four-Year Follow-Up of Endobronchial Lung Volume Reduction in Alpha-1-Antitrypsin Deficiency Patients: A Case Series

Hillerdal

Mindus

2014

Respiration

Self Cite

View full text Add to dashboard Cite

Background: Lung volume reduction surgery can improve lung function and working capacity in severe heterogeneous emphysema. Endobronchial lung volume reduction (ELVR) performed by one-way valves inserted via a flexible bronchoscope can result in a moderate but significant improvement in lung function and exercise tolerance, eliminating the surgical risks. Objectives: Most studies of this method have excluded patients with α₁-antitrypsin (AAT) deficiency, but small series of cases with positive short-term outcome have been reported. The sustainability of results has been questioned and we here present our experience in AAT-deficient patients treated with ELVR followed up for up to 4 years. Methods: From August 2008 to January 2012, 15 patients were treated with ELVR. Inclusion criteria were homozygotic AAT deficiency, age <80 years, residual volume of 140% or more, forced expiratory volume in 1 s (FEV₁) 15-45% of predicted, severe heterogeneous emphysema, symptoms severely restricting daily life, informed consent and absence of other serious diseases. Results: One patient coughed up valves after 2 months, 1 developed pneumothorax and had valve displacement and subsequent removal, and 1 improved from an FEV₁ of 0.62 to 0.84 liters, but after 4 months developed repeated and severe pneumonia and the valves had to be removed. Thus, 12 patients remained and were followed up for at least 1 year. In these patients, FEV₁ increased (mean: 54%), the quality of life was much improved, and 2 patients could be taken off oxygen therapy. During the 4-year follow-up, patients demonstrated no significant deterioration in lung function. Conclusion: In carefully selected AAT deficiency patients with severe emphysema, ELVR can be safely performed with encouraging long-lasting results.

show abstract

Comparison of Lung Volume Reduction Surgery and Physical Training on Health Status and Physiologic Outcomes

Cited by 40 publications

References 27 publications

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Predictive validity of short-form health survey [36 items] scales for chronic obstructive pulmonary disease exacerbation

One- to Four-Year Follow-Up of Endobronchial Lung Volume Reduction in Alpha-1-Antitrypsin Deficiency Patients: A Case Series

Contact Info

Product

Resources

About