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Can CT Measurement of Emphysema Severity Aid Patient Selection for Lung Volume Reduction Surgery?

Steve H. Salzman, MD, FCCP
Author and Funding Information

Affiliations: New York, NY 
 ,  Dr. Salzman is Director, Pulmonary Function Laboratories, Beth Israel Medical Center, and Associate Professor of Clinical Medicine, Albert Einstein College of Medicine, New York, NY.

Correspondence to: Steve H. Salzman, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, First Ave at 16th St, New York, NY 10003; e-mail: ssalzman@bethisraelny.org



Chest. 2000;118(5):1231-1232. doi:10.1378/chest.118.5.1231
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Initially, it seemed a paradox that the surgical removal of lung tissue in patients with severe emphysema resulted in improvement in pulmonary mechanics, symptoms, and exercise capacity. The data now emerging have explained this largely on the basis of an increase in lung elastic recoil and improvement in respiratory muscle function. Changes in lung structure due to emphysema leads to a “mismatch” in the size of the patient’s lung and chest wall. The lung is too large for the chest wall, placing the diaphragm in a flat and short position, which is suboptimal for force generation. Conversely, the chest wall is too small to allow the lung to expand to a volume at which elastic recoil pressures are high enough to maintain adequate flow rates and tether airways to avoid air trapping. The removal of lung tissue allows the remaining lung to expand enough to achieve a more normal recoil pressure, maintaining the patency of surrounding airways, and increasing the driving pressures for expiratory flow. FEV1, FVC, and measures of hyperinflation, most particularly the ratio of residual volume (RV) to total lung capacity (TLC), all improve. The smaller lung allows recovery to normal diaphragmatic curvature and force generation.

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