Lung Volume Reduction Surgery and Quality of Life

1. Lung Volume Reduction Surgery and Quality of Life Amy Burker ALHE 4060/ Masini April 22, 2007

2. Emphysema • Emphysema is a chronic lung condition that affects approximately two million Americans over the age of fifty, costs more than 2.5 billion dollars in health care expenses annually, and causes or is related to 100,000 deaths in the U.S. per year (NETT). • This disease is characterized by reduced lung elasticity. *“National Emphysema Treatment Trial (NETT): Evaluation of Lung Volume Reduction Surgery for Emphysema”. National Heart, Lung, and Blood Institute. 1 March 2007. <http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm>.

3. LVRS • Lung volume reduction surgery (LVRS) removes the most damaged part of the lung; usually about twenty to thirty five percent of each lung is removed. • By removing the highly damaged areas of the lung, the healthier portions can fill and empty more completely. • This also allows the muscles of ventilation, including the diaphragm, to return to normal shape. As a result, a patient’s work of breathing is decreased and oxygenation improves (NETT, Temple Univ). *“National Emphysema Treatment Trial (NETT): Evaluation of Lung Volume Reduction Surgery for Emphysema”. National Heart, Lung, and Blood Institute. 1 March 2007. <http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm>. *“Lung Volume Reduction Surgery”. 2004. Temple Lung Center. Temple University Health System. 1 March 2007. <http://www.templehealth.org/lvrs/index.html>.

4. Problem Statement • As emphysema continues to effect numerous amounts of people, treatments need to advance to slow, correct or at some point even prevent the disease. • Research for current treatments, such as LVRS, needs to continue so that efficacy can be evaluated. • Thus, the need to closely examine whether LVRS provides an increased quality of life for patients emerges.

5. Methods • Participants in this study participated in the NETT, underwent LVRS, prior to surgery had primarily upper lobe emphysema, and continued with pulmonary rehabilitation. • From this population, a random sample was selected and divided into two groups of high exercise capacity and low exercise capacity as it was before LVRS. According to the review of literature, these patients are the most likely to benefit from the surgery, therefore this population best exhibits the effects of LVRS on quality of life and lung function improvement. • The goal of the study is to closely examine the aforementioned variables through scheduled participant interviews and a BODE index evaluation upon starting the study, at 6 months, 12 months, and yearly thereafter. Participants’ adherence to medical regimens, abstinence from tobacco use, and pulmonary rehabilitation treatment at home were monitored through weekly telephone calls and monthly clinic visits. Patients’ BODE index variables, BMI, degree of airflow obstruction assessed by spirometry, grade of dyspnea, and exercise capacity assessed by 6 minute walk, were analyzed with the use of a series of multiple regressions.

6. Conclusions • With a close study of participants from the NETT who had primarily upper lobe emphysema and either high or low exercise capacities, the data indicates an increase in quality of life. • Thus, there is further development of criteria for the determination of future LVRS patients.