Nonsurgical bronchoscopic interventions continue to improve; they have been designed to achieve similar results to LVRS
(but with less morbidity), and provide a possible intervention for patients with heterogenous or homogenous emphysema, and significant hyperinflation refractory to optimized medical care.
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.
Participants with mostly non-upper-lobe disease and with high exercise capacity had poorer survival after LVRS
than after medical treatment.
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.
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).
8) However, in selected patients with severe effort intolerance and predominantly upper-lobe emphysema, LVRS
can lead to improvements in functional status and mortality.
JCAHO said it will work with the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid (CMS) in its quest to improve the quality and safety of care for patients undergoing LVRS
in the US.
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.
According to the CMS national coverage analysis statement, LVRS
is "reasonable and necessary" for patients who fit the NETT definition of non-high risk and who present with severe non-upper lobe emphysema and low exercise capacity or with severe upper lobe emphysema.