In addition to improving survival, LVRS
improves lung function, dyspnea, and exercise tolerance in selected patients with advanced pulmonary emphysema.
Abbreviations: 6MWT = 6-minute walk test; BD = bronchodilator; Beck = Beck Depression Inventory; BMI = body mass index; Borg = Borg score for breathlessness, COPD = chronic obstructive pulmonary disease; CPET = cardiopulmonary exercise testing; DLCO = single-breath diffusing capacity of the lung for carbon monoxide; FEV1 = forced expiratory volume in 1 second; GOLD = Global Initiative for Chronic Obstructive Lung Disease; HRQL = health-related quality of life; LVRS
= lung-volume-reduction surgery; MCS = Mental Component Summary; MOS SF-36 = Medical Outcomes Study 36-Item Short Form; NETT = National Emphysema Treatment Trial; NIH = National Institutes of Health; PCS = Physical Component Summary; QWB-SA = Self-Administered Quality-of-Well-Being Scale; RV = residual volume; SGRQ-TS = St.
Of the 93 patients in the two trials, 54 were randomized to LVRS
and 39 to medical treatment, including pulmonary rehabilitation, smoking cessation, yearly vaccination, and oxygen therapy, as well as therapy with bronchodilators, corticosteroids, and antibiotics (Chest 2005;127:1166-77).
JCAHO says the Centers for Medicare and Medicaid (CMS) plans to extend payment coverage for the procedure for emphysema patients and called on the organization to develop both standards and a national LVRS
David Dove, MD, CEO of Aeris Therapeutics commented, "These data demonstrate that the AeriSeal System can improve lung function at 12 months similar to results reported with LVRS
, but with substantially less morbidity.
Although there is sometimes a perception that we have limited treatment options for COPD, the ones we do have, including inhaled medications, programs of rehabilitative exercise, and in appropriately selected patients LVRS
can make a huge difference in a person's quality of life," said Kalhan, who is also an associate professor of medicine at the Feinberg School.
To be included in this study all subjects were candidates who had undergone LVRS
and participated in pulmonary rehabilitation after LVRS
at Chapman Medical Center (Orange, CA).
BLVR aims to provide the same benefits as LVRS
by placing endobronchial devices via a bronchoscope into airways supplying emphysematous, hyperinflated parts of the lung.
CMS recently announced it will provide coverage for LVRS
for certain beneficiaries and has requested private accreditors such as JCAHO to develop LVRS
The results of the 5-year multicenter study, which randomized 1,218 patients to either bilateral LVRS
or medical therapy, suggested that the surgery is associated with a survival benefit in emphysema patients with upper lobe disease and low exercise capacity.
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They used a case-series analysis approach and examined the effects of LVRS
on HRQL and correlated these effects with PFTs, gas exchange, exercise performance, and alterations in medical management.