Lung Reduction

 
 
 
Lung Reduction Improves Quality of Life
By Chris Emery, Contributing Writer, MedPage Today
Published: July 29, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

 

PRINCETON, N.J., July 29 — Lung volume reduction surgery can prolong and improve the quality of life for patients with severe emphysema, according to the first head-to-head study comparing the surgery to nonsurgical medical care.Action Points  


  • Explain to interested patients that research has shown that lung volume reduction surgery improves survival and quality of life for people with upper-lobe-predominant emphysema.
  • Note that the study found no significant effect of lung volume reduction surgery for patients who had non-upper-lobe predominant emphysema.

Patients with severe emphysema in their upper lung lobes who had lung volume reduction surgery (LVRS) went an average of two years before experiencing a serious deterioration in quality of life or dying, compared to only one year for patients who received medical treatment (P<0.0001), according a report in the August 1 issue of American Journal of Respiratory and Critical Care Medicine.

“The trajectory for the LVRS group remained clinically and statistically different than that of the medical treatment group in the second year and throughout the five-year period,” Roberto P. Benzo, MD, MSc, of the Mayo Clinic, and colleagues wrote.

“These findings confirm a palliative effect of LVRS, with initial improvement of [quality of life] and subsequent maintenance of the improvement over time.”

The authors cautioned that LVRS carries a 5% risk of death in the postoperative period. In fact, during the first six months after randomization, the medical treatment group fared better than the LVRS group, a finding the researchers attribute to surgery-related mortality.

During the study, known as the National Emphysema Treatment Trial, 1,218 patients with severe emphysema were randomized to receive either medical treatment (n=610) or LVRS (n=608). The mean age of patients in both groups was 67.

During the lung reduction surgeries, emphysematous lung tissue was removed to decrease air trapping and, consequently, shortness of breath. Nonsurgical treatment generally consisted of customized use of medication, oxygen support, smoking cessation, and pulmonary rehabilitation.

Before they were randomized, the participants completed the St. George’s Respiratory Questionnaire, a standardized measure of quality of life for patients with chronic respiratory disease. The patients were followed for five years, or until they died. The subjects completed the quality of life questionnaire at regular intervals during the studies.

In addition to characterizing the patients based on upper-lobe and lower-lobe-predominant emphysema, the researchers graded them on their exercise capacity as determined by a cycle ergometry test.

The primary outcome of the study was a composite endpoint consisting of death or an “unquestionable and meaningful deterioration” in quality of life, defined as an 8-point or greater drop on the respiratory questionnaire.

Patients who suffered from emphysema that was predominantly in the upper lobes of their lungs (about 65% of the participants), saw significant improvements in survival and quality of life in the first two years. While the benefit began to diminish after two years, some improvement over the medical treatment group persisted for the entire five years of the study.

Among the upper-lobe-predominant patients, those with high exercise capacity faired particularly well with LVRS. The researchers found no significant effect for patients who had non-upper-lobe predominant emphysema.

The authors wrote that the inclusion of quality of life assessments provides support for the use of LVRS in the clinical care of patients with severe emphysema.

“[Quality of life] measures are highly relevant to patient choices and confirm the rationale for using LVRS as a palliative tool,” they wrote. “Our findings are relevant for recommending LVRS for patients with upper-lobe-predominant emphysema and, in particular, those with high exercise capacity, a subset of patients in whom the survival benefits may be marginal but in whom the combined survival and [quality of life] benefits are pronounced.”

The study was funded by the National Institutes of Health.Several of authors reported receiving consulting, speaking, and other fees from companies, including AstraZeneca, Medacorp, Boehringer Ingelheim, GlaxoSmithKline, Aeris, Novartis, BIPI, Pfizer, Emphasys, Genentech, Spiration, Medimmune, Centocor, Stryker, Axcan, Angiodynamics, Oncotech and U.S. Surgical/Coviden. A.P.F.

 

 
 
 

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