Less Lung Means More Comfort for Emphysema Patients
Oct. 24, 2000 -- Emphysema causes a person's lungs to become stretched out and floppy, unable to bounce back after each breath. People with severe emphysema may need extra oxygen just to get through the day, and many are so short of breath they can barely walk across a room. Lung experts think that making a few tucks to tighten up each lung might provide some relief for such people, and two studies reported this week at a meeting of the American College of Chest Physicians suggest that they may be right.
Both studies involve an operation called lung volume reduction surgery (LVRS), which has been under development for several years. Sheila Goodnight-White, MD, author of one of the studies, reports that emphysema patients treated with the surgery saw major improvements in their lung function and ability to exercise, while patients who got standard medical therapy continued to go downhill. Roger Yusen, MD, author of the other study, reports that the improvements for patients treated with LVRS lasted up to five years after surgery. Goodnight-White is with the Veterans Affairs Medical Center and Baylor College of Medicine in Houston; Yusen is with Barnes Jewish Hospital, Washington University School of Medicine in St. Louis.
Lung volume reduction surgery works by actually making the lungs smaller. This pulls open the airways and allows the breathing muscles to return to a more normal and comfortable position, making breathing easier. The surgery can be done on both lungs, either by inserting a tube through the chest wall or making an incision down the center of the breastbone. Small sections of each lung are then removed.
Amir Sharafkhaneh, MD, who is working with Goodnight-White on the Houston study, tells WebMD that all patients in the study go through a six- to 10-week rehabilitation program that includes medications and oxygen as needed, plus exercise and instruction in breathing methods. The patients are then randomly assigned either to have LVRS or continue regular medical treatment.
Safety has been a concern with this dramatic surgical procedure, but Sharafkhaneh says that only 4% of the LVRS patients had died by six months after surgery, compared with 17% of those who continued standard medical treatment.
When patients were studied three months after surgery, the lungs of those who had had LVRS were functioning much better than those of patients treated with standard medical care. After six months, the patients who had LVRS were able to walk farther than at the beginning of the study, while the other patients could not walk as far as they could when the study began.
But do these improvements last? Yusen and colleagues say they do. The St. Louis group so far has treated 200 patients with the surgery and has studied them for five years. Yusen says that 83% of patients survived for three years after surgery, and 71% of patients survived for five years or more.
The St. Louis emphysema patients had better lung function after the surgery, and the majority of those who needed to use oxygen frequently before surgery were able to discontinue oxygen afterwards.
Yusen found that three years after surgery, half of the patients still reported a greatly improved ability to breathe, and 84% reported good to excellent satisfaction with their outcomes.
He points out that this treatment is for patients who still have severe symptoms despite the best care with medication.