Improvements in Lung Function, Exercise, and Quality of Life in Hypercapnic COPD Patients After Lung Volume Reduction Surgery

O’Brien, Gerard; Furukawa, Satoshi; Kuzma, Anne Marie; Cordova, Francis; Criner, Gerard J.

doi:10.1378/chest.115.1.75

Cited by 50 publications

(21 citation statements)

References 28 publications

(23 reference statements)

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“…HRQL after LVRS has also been assessed by other instruments, such as the Nottingham Health Profile [10,13], the Sickness Impact Profile [12,18,32,42], the Chronic Respiratory Disease Questionnaire [15] and the St. George9s respiratory Questionnaire [17]. In general, positive effects were found.…”

Section: Discussionmentioning

confidence: 99%

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Improved quality of life after lung volume reduction surgery

Hamacher¹,

S²,

C³

et al. 2002

Eur Respir J

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Lung volume reduction surgery (LVRS) improves dyspnoea, pulmonary function, and physical performance in patients with severe pulmonary emphysema. This study investigated the impact of LVRS on health-related quality of life (HRQL) over a 2-yr period following surgery.Thirty-nine consecutive patients were prospectively assessed before LVRS, and followed over 24 months postoperatively. The assessments included pulmonary function, dyspnoea (Medical Research Council (MRC) dyspnoea score), 6-min walking distance (6MWD) and HRQL using the Short Form 36-item questionnaire (SF-36) .Several domains of SF-36 improved considerably over 2 yrs after surgery: Physical Functioning: 39 ¡ 4 (mean ¡ SEM) versus 16 ¡ 2 (pv0.01); Vitality: 51 ¡ 3 versus 32 ¡ 3 (pv0.01); Social Functioning: 72 ¡ 4 versus 51 ¡ 5 (pv0.01). Also, improvements in pulmonary function (forced expiratory volume in one second (FEV1): 27 ¡ 1% predicted, residual volume (RV)/total lung capacity (TLC): 0.65¡0.01), 6 MWD (274¡16 m) and dyspnoea (MRC: 3.9¡01) were sustained for up to 2 yrs after LVRS (FEV1 36¡2% pred, RV/TLC: 0.58¡0.02; 6 MWD: 342¡19 m; MRC: 2.0¡0.2; pv0.05).In patients with severe emphysema, lung volume reduction surgery had positive effects on health-related quality of life and pulmonary function over 2 yrs.

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Section: Discussionmentioning

confidence: 99%

“…the Short Form 36-item questionnaire (SF-36), as in the present study [10,14]. Others followed aspects of quality of life in LVRS for up to 6 months only [11,[15][16][17][18] or 12 months [19] or reported for a longer time period, but only a small number of patients were followed for up to 18 months [12,13].…”

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confidence: 88%

Improved quality of life after lung volume reduction surgery

Hamacher¹,

S²,

C³

et al. 2002

Eur Respir J

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“…Identification of factors that accurately and consistently predict adverse outcome is necessary to develop evidence-based exclusion criteria. Many series of LVRS have reported a variety of demographic, radiologic, and/or physiologic characteristics that predicted higher operative risk (Table 4) (9,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Unfortunately, most were small, retrospective, single-institution, case-controlled series with selection bias and incomplete or inconsistent data collection.…”

Section: Mortalitymentioning

confidence: 99%

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

DeCamp¹,

McKenna²,

Deschamps³

et al. 2008

Proceedings of the American Thoracic Society

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The objective of lung volume reduction surgery (LVRS) is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Appropriate patient selection and preoperative preparation are prerequisites for successful LVRS. An effective LVRS program requires participation by and communication between experts from pulmonary medicine, thoracic surgery, thoracic anesthesiology, critical care medicine, rehabilitation medicine, respiratory therapy, chest radiology, and nursing. The critical analysis of perioperative outcomes has influenced details of the conduct of the procedure and has established a bilateral, stapled approach as the standard of care for LVRS. The National Emphysema Treatment Trial (NETT) remains the world's largest multi-center, randomized trial comparing LVRS to maximal medical therapy. NETT purposely enrolled a broad spectrum of anatomic patterns of emphysema. This, along with the prospective, audited collection of extensive demographic, physiologic, radiographic, surgical and quality-of-life data, has positioned NETT as the most robust repository of evidence to guide the refinement of patient selection criteria for LVRS, to assist surgeons in providing optimal intraoperative and postoperative care, and to establish benchmarks for survival, complication rates, return to independent living, and durability of response. This article reviews the evolution of current LVRS practice with a particular emphasis on technical aspects of the operation, including the predictors and consequences of its most common complications.Keywords: emphysema; surgery; complications; outcomes Pneumectomy or the nonanatomic resection of emphysematous lung by thoracotomy to palliate chronic dyspnea was proposed and tested by Otto Brantigan in the 1950s (1). While the physiologic principles of the procedure appeared to benefit survivors, operative morbidity and mortality proved prohibitive and relegated the procedure to the obscure pages of the history of surgery for emphysema, where it lay alongside costochondrectomy, phrenic nerve lysis, and glomectomy (2). Joel Cooper and colleagues resurrected the concept of partial pneumectomy nearly four decades later, advocating a bilateral, nonanatomic, stapled resection through a median sternotomy. Forty years of advances in anesthesia, critical care, pulmonary rehabilitation, and surgical instrumentation, along with the expertise of the Washington University group, yielded a considerable reduction in operative morbidity and mortality, and lung volume reduction surgery (LVRS) was (re)born (3).The objective of LVRS is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Before the National Emphysema Treatment Trial (NETT), there were several reported single institutional, case-controlled series of LVRS demonstrating encouraging results with regard to mean improvements in spirometry, 6-minute-walk distance, self-reported dyspnea, and supplemental oxygen use (...

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“…Cordova et al (1997) also reported that the SIP-overall score improved at 3 months after LVRS and was sustained for 12 months. Moreover, O'Brien et al (1999) reported that patients with moderate to severe resting hypercapnia also had significantly improved SIP scores between 3 and 6 months after LVRS. In the present study, we observed an improvement in SIP scores up to 36 months after LVRS.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Beneficial Effects of Lung Volume Reduction Surgery on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Gotö

Kohzuki²,

Meguro³

et al. 2007

Tohoku J. Exp. Med.

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Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation, which results in exertional dyspnea and physical disability. Subsequently, those cause a difficulty in performing routine activities of daily living and affect their health-related quality of life (HRQOL). Lung volume reduction surgery (LVRS) has been reported to be an effective treatment for selected patients with advanced COPD to improve pulmonary function, lung mechanics, exercise tolerance, and dyspnea. However, the long-term effects of LVRS on HRQOL have not been fully investigated. Therefore the effects of LVRS on generic and disease-specific HRQOL were assessed in patients with COPD following LVRS for 36 months. Nineteen patients (65.1 ± 7.0 [mean ± S.D.] years old) who underwent pulmonary rehabilitation plus LVRS (LVRS group), and 8 patients (67.2 ± 5.8 years old) who did pulmonary rehabilitation but not LVRS (Medical group) were studied. In both groups, optimal medication was given throughout this period. Generic HRQOL and diseasespecific HRQOL were evaluated before rehabilitation, and 3, 12, 24, and 36 months after LVRS. Following LVRS, the generic HRQOL was significantly improved and the diseasespecific HRQOL was maintained up to 36 months. In Medical group, disease-specific HRQOL rapidly deteriorated. In conclusion, the long-term effects of LVRS on HRQOL in COPD patients were maintained up to 36 months compared with Medical group. Both generic and disease-specific HRQOL changed differently, suggesting the importance of both assessments especially in long-term follow up.sickness impact profile; visual analogue scale; rehabilitation; lung volume reduction surgery; quality of life © 2007 Tohoku University Medical PressChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. The prevalence of COPD was 3.6% in all Japanese subjects (Takemura et al. 2005) and at least 8.6% in the general Japanese population aged over 40 years (Fukuchi et al. 2004); males in their 50s and over 60 years old and females over 60 years old showed remarkably

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Improvements in Lung Function, Exercise, and Quality of Life in Hypercapnic COPD Patients After Lung Volume Reduction Surgery

Cited by 50 publications

References 28 publications

Improved quality of life after lung volume reduction surgery

Improved quality of life after lung volume reduction surgery

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

Long-Term Beneficial Effects of Lung Volume Reduction Surgery on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

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