Lung Surgery Helps, but Doesn't Cure Emphysema
Nov. 3, 1999 (Chicago) -- It may sound odd, but cutting out the diseased portions of the lungs in patients with severe emphysema actually helps them. A new study shows that patients with end-stage emphysema report that they feel better for several years after they undergo lung volume reduction surgery, according to lead author Roger D. Yusen, MD, speaking here at a meeting of lung specialists, the American College of Chest Physicians. These patients also have a relatively high survival rate compared with emphysema patients who are treated with standard medications.
"This is a reasonable ... treatment for patients with severe [emphysema] who no longer get relief from medical therapy," Yusen tells WebMD. "Our results were encouraging ... but the public needs to know that this surgery is not a cure ... for emphysema." He says the surgery is designed only to relieve patients' symptoms. Yusen is an assistant professor of pulmonary and critical care medicine at Washington University in St. Louis, where he is a staff physician at Barnes-Jewish Medical Center.
Emphysema is a chronic, progressive disease of the lungs that affects an estimated 14 million people in the U.S. The disease, usually brought on by smoking, causes enlargement of the air sacs in the lungs, making it difficult for the person to expel air. In end-stage disease, most therapies, such as inhalers, no longer work, and lung transplantation becomes the only option -- until recently.
Previous studies have shown that the surgery improves outcomes and symptoms, but the long-term quality of life had yet to be assessed.
In this latest study, the investigators compared patients' assessments of their health with their reports on a 100-item questionnaire, which the patients had filled out before surgery and then completed annually for five years following the surgery. Yusen and his co-investigators also assessed the patients' survival rates. The patients in the study were 192 of the first 200 patients to undergo the procedure at their institution.
All patients who underwent the surgery had severe lung disease due to emphysema, despite intense medical therapy. Their symptoms included severe shortness of breath due to airflow obstruction. The patients' average age was 62 years; 48% of them were women.
The patients were eligible for the surgery if they had areas in their lungs that could be targeted for removal because other areas were less damaged. Typically, these target sites were in the upper lobes of the lungs. The patients had no other major health problems, such as significant coronary artery disease, any cancers that would lead to death within six months, or imbalances of carbon dioxide and oxygen in their blood.
The questionnaire addressed the patients' perception of their overall physical function and quality of life. The highest possible total score was 100; the average score in the general population was 50. Prior to surgery, patients had an average score of 28. By the study's end, the average score was 40, a significant improvement.