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Stability of Improvements in Exercise Performance and Quality of Life Following Bilateral Lung Volume Reduction Surgery in Severe COPD

Francis Cordova; Gerald O'Brien; Satoshi Furukawa; Ann Marie Kuzma; John Travaline; Gerard J. Criner
Author and Funding Information

Affiliations: From the Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia,  From the Division of Cardiothoracic Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia

Affiliations: From the Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia,  From the Division of Cardiothoracic Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia


1997 by the American College of Chest Physicians


Chest. 1997;112(4):907-915. doi:10.1378/chest.112.4.907
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Abstract

Study objective: To evaluate the long-term stability of improvements in exercise capacity and quality of life (QOL) after lung volume reduction surgery (LVRS).

Design: Case-series analysis.

Setting: University hospital.

Patients: Twenty-six patients with severe airflow obstruction (mean FEV1 of 0.67±0.18 L) and moderate to severe hyperinflation (mean total lung capacity of 7.30±1.90 L).

Intervention and measurements: All patients underwent bilateral LVRS via median sternotomy. Serial measurement of lung function, symptom-limited cardiopulmonary exercise tests, 6-min walk distances (6MWD), and sickness impact profile (SIP) scores were done before, and at 3, 6, 12, and 18 months after surgery.

Results: FEV1 (0.93±0.29 vs 0.68±0.19 L, p<0.001) increased while residual volume (3.47±1.2 vs 4.77±1.5 L, p<0.001) decreased significantly at 3 months post-LVRS compared to baseline, and these changes were maintained at 12 to 18 months follow-up. Similarly, the increase in 6MWD at 3 months post-LVRS (340±84 vs 251±114 m, p<0.001) was sustained at all follow-up times. On cardiopulmonary exercise testing, total exercise time (9.0±1.8 vs 6.1±1.9 min, p<0.001), oxygen uptake at peak exercise (VO2 peak) (14.9±4 vs 11.9±3 mL/kg/min, p<0.001), maximum oxygen pulse (7.43±2.37 vs 5.85±1.96 mL/beat, p<0.005), and maximum minute ventilation (VEmax) (30.3±10 vs 23.5±7.1 L/min, p<0.001) increased significantly at 3 months post-LVRS. On serial study following LVRS, total exercise time remained significantly greater at 6 (8.5±1.38 min) and 12 months (8.71±2.0 min) post-LVRS compared to baseline (5.81±1.9 min, p<0.05). VO2 peak tended to be higher at all follow-up periods (3 months, 16.1±4.3; 6 months, 14.5±2.6; 12 months, 14.1±3.5 mL/kg) compared to baseline (12.6±3.9 mL/kg, p=0.08). Similarly, maximum O2 pulse tended to be higher in all follow-up studies (3 months, 8.45±2.7; 6 months, 7.6±1.7; 12 months, 7.42±2.1 mL/beat) compared to baseline (6.39±2.5 mL/beat, p=0.06). Higher VEmax continued to be observed at 6 (30±10 L/min) and 12 months (28±10 L/min) post-LVRS, compared to baseline (23±7 L/min, p=0.02). VEmax post-LVRS was significantly higher at 3 and 6 months compared to baseline on post-hoc analysis (p<0.05). Overall SIP scores were lower at 3 months (7 vs 18, p<0.0002) post-LVRS and were sustained in long-term follow-up.

Conclusion: We conclude that bilateral LVRS via median sternotomy in selected patients with severe, diffuse emphysema improves exercise performance and QOL at 3 months following LVRS and these improvements are maintained for at least 12 to 18 months in follow-up.


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