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Improvements in Lung and Respiratory Muscle Function Following Lung Volume Reduction Surgery : Smaller May Be Better, But How Long Does It Last?

Ahmet Baydur, MD, FCCP
Author and Funding Information

Affiliations: Los Angeles, CA 
 ,  Dr. Baydur is Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California.

Correspondence to: Ahmet Baydur, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Southern California, 2025 Zonal Avenue, GNH 11-900, Los Angeles, CA 90033



Chest. 1999;116(6):1507-1509. doi:10.1378/chest.116.6.1507
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Extract

Since lung volume reduction surgery (LVRS) was introduced in 1992, considerable controversy has revolved around this procedure that improves dyspnea and quality of life in patients with COPD. Measurements of physiologic variables of airway obstruction, elastic recoil pressure, gas exchange, and exercise capacity all improve within the first year after LVRS. These findings occur more dramatically with bilateral rather than with unilateral resection. In addition to these changes in conventional lung volumes and mechanics, there are at least short-term improvements in respiratory muscle function or control of ventilation in patients with severe emphysema who have undergone LVRS. In this issue of CHEST (see page 1593), Lahrmann and colleagues describe an elegant study in which they assessed the relationship between dyspnea and respiratory mechanics, muscle function, and central drive at 1, 6, and 12 months after LVRS. As expected, they found significant increases from preoperative values in FEV1 and decreases in residual volume (RV) and total lung capacity (TLC) 1 month after LVRS. More intriguing were their findings that maximum exercise capacity, maximum oxygen uptake, respiratory muscle strength, endurance capacity, central diaphragmatic drive, and dyspnea during loaded breathing all reached statistical significance not less than 6 months after LVRS. Of some clinical importance is their additional finding that even as FEV1, TLC, and RV began to return to preoperative values 12 months after LVRS, respiratory muscle function continued to improve, while intrinsic positive end-expiratory pressure decreased further during this period. Since it has been shown that diaphragmatic activity decreases when muscle length decreases for a given neural drive,1 factors other than changes in lung volume and a resumption of a more advantageous operational length of the respiratory muscles must account for the improvement in respiratory muscle function and dyspnea.


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