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Lung volume reduction surgery shown to prolong and improve life for some emphysema patients
July 24, 2009Lung volume reduction surgery (LVRS) can have a significantly beneficial effect in patients with severe emphysema, according to the first ever study to randomize emphysema patients to receive either LVRS or non-surgical medical care.
"We found lung reduction surgery is good treatment alternative for selected emphysema patients since it not only improves survival but also meaningfully improves quality of life for a period of at least five years after the operation," said lead author of the study, Roberto Benzo, M.D., MSc. of the Mayo Clinic. "Patients who underwent LVRS, with the exception of those who had non-upper-lobe-predominant emphysema, had both a survival and quality of life benefit when compared to similar patients undergoing medical treatment only."
The results of the National Emphysema Treatment Trial (NETT) study were reported in the August 1 issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
The NETT group recruited 1,218 patients with severe emphysema and randomized them to either undergo LVRS or non-surgical medical treatment, which generally consisted of customized use of medication, oxygen support, smoking cessation and pulmonary rehabilitation. LVRS consists of removing a portion of emphysematous lung tissue in the patient. While removing lung tissue in patients whose breathing is compromised may seem counterintuitive, severe emphysema causes "air trapping", where the patient can inhale, but is unable to force the air back out of the lung. This is one of the main causes of shortness of breath in patients with emphysema.
"By removing the section of lung that is primarily affected with severe emphysema, we can decrease air trapping and consequently the shortness of breath, which can thereby improve the patient's perceived quality of life," explained Dr. Benzo.
A total of 608 patients underwent LVRS and 610 received standard medical care. The patients were followed for five years or until they died. All endpoints except death were measured at six-month intervals. The primary outcome 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 Saint George's Respiratory Questionnaire, a widely used standardized measure of quality of life in patients with respiratory disease.
In the total sample, the average time until a "composite event"-either death or a serious decline in quality of life- was one year for medically treated patients and two years for patients who had undergone LVRS. Patients whose emphysema was predominantly found in the upper lobes of their lungs-about 65 percent of emphysema patients- also showed quality of life and survival benefits greater than survival benefits alone, suggesting that they lived longer and better.
However, LVRS has a small but inherent danger of perioperative mortality.
"LVRS has risks that patients need to understand and acknowledge," said Dr. Benzo. "In NETT, close to five percent of the patients undergoing lung reduction died in the post-operative period. However, once the post operative period is over, the quality of life benefit comes right away."
"NETT was landmark study: randomization was necessary at that point as we did not know the true benefits of the surgery," said Dr. Benzo. "We now know the individuals that benefit from it. Randomization would be unethical now in the group of individuals that we now know get benefit. This study shed light on the palliative (overall well-being) benefits of the surgery, which many patients consider as important as the survival benefit.
American Thoracic Society
The NETT group recruited 1,218 patients with severe emphysema and randomized them to either undergo LVRS or non-surgical medical treatment, which generally consisted of customized use of medication, oxygen support, smoking cessation and pulmonary rehabilitation. LVRS consists of removing a portion of emphysematous lung tissue in the patient. While removing lung tissue in patients whose breathing is compromised may seem counterintuitive, severe emphysema causes "air trapping", where the patient can inhale, but is unable to force the air back out of the lung. This is one of the main causes of shortness of breath in patients with emphysema.
"By removing the section of lung that is primarily affected with severe emphysema, we can decrease air trapping and consequently the shortness of breath, which can thereby improve the patient's perceived quality of life," explained Dr. Benzo.
A total of 608 patients underwent LVRS and 610 received standard medical care. The patients were followed for five years or until they died. All endpoints except death were measured at six-month intervals. The primary outcome 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 Saint George's Respiratory Questionnaire, a widely used standardized measure of quality of life in patients with respiratory disease.
In the total sample, the average time until a "composite event"-either death or a serious decline in quality of life- was one year for medically treated patients and two years for patients who had undergone LVRS. Patients whose emphysema was predominantly found in the upper lobes of their lungs-about 65 percent of emphysema patients- also showed quality of life and survival benefits greater than survival benefits alone, suggesting that they lived longer and better.
However, LVRS has a small but inherent danger of perioperative mortality.
"LVRS has risks that patients need to understand and acknowledge," said Dr. Benzo. "In NETT, close to five percent of the patients undergoing lung reduction died in the post-operative period. However, once the post operative period is over, the quality of life benefit comes right away."
"NETT was landmark study: randomization was necessary at that point as we did not know the true benefits of the surgery," said Dr. Benzo. "We now know the individuals that benefit from it. Randomization would be unethical now in the group of individuals that we now know get benefit. This study shed light on the palliative (overall well-being) benefits of the surgery, which many patients consider as important as the survival benefit.
American Thoracic Society
Emphysema Current Events and Emphysema News RSSU.S. and European Experts Applaud Creation of New Transatlantic Task Force on Global Antibiotic Resistance Threat
Experts on both sides of the Atlantic applaud President Barack Obama and Swedish Prime Minister Fredrik Reinfeldt, representing the European Union (EU) Presidency, for establishing a transatlantic task force to address antibiotic resistance, an urgent and growing problem that threatens patient safety and public health worldwide.
Stereotactic radiotherapy offers noninvasive, effective treatment for frail patients with early-stage lung cancer
Stereotactic body radiation therapy (SBRT) should be considered a new standard of care for early-stage lung cancer treatment in patients with co-existing medical problems, according to results from a national clinical trial led by UT Southwestern Medical Center physicians.
Survey: Awareness of COPD is rising, but understanding is still low
Awareness of COPD-chronic obstructive pulmonary disease-continues to grow in the United States, according to national survey results released today by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.
UT scientists discover link between protein and lung disease
In a development that could lead to a novel approach to the treatment of a devastating lung disease, biochemists at The University of Texas Health Science Center at Houston report they are the first to link the osteopontin (OPN) protein to chronic obstructive pulmonary disease (COPD).
New genes at work in patients with hereditary lung disease
University of Florida researchers have safely given new, functional genes to patients with a hereditary defect that can lead to fatal lung and liver diseases, according to clinical trial findings slated to appear this week in the online early edition of the Proceedings of the National Academy of Sciences.
New genes at work in patients with hereditary lung disease
Researchers at the University of Massachusetts Medical School and the University of Florida in Gainesville have safely given new, functional genes to patients with a hereditary defect that can lead to fatal lung and liver diseases.
Scientists open doors to diagnosis of emphysema
Chronic inflammatory lung diseases like chronic bronchitis and emphysema are a major global health problem, and the fourth leading cause of death and disability in developed countries, with smoking accounting for 90% of the risk for developing them.
Emphysema severity directly linked to coal dust exposure
Coal dust exposure is directly linked to severity of emphysema in smokers and nonsmokers alike, according to new research from the National Institute for Occupational Safety and Health (NIOSH).
Protein may be strongest indicator of rare lung disease, study shows
Researchers at the University of Cincinnati (UC) have discovered a protein in the lungs that can help in determining progression of the rare lung disease Idiopathic Pulmonary Fibrosis (IPF).
Early exposure to tobacco smoke may lead to early emphysema later
Chronic exposure to tobacco smoke in childhood may contribute to early emphysema later in life, according to new research.
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