Obstructive Lung Diseases |

Lung Volume Reduction Following Recurrent Pneumonia; Unusual Finding in a COPD Patient FREE TO VIEW

Yihenew Negatu, MD; Philip Diaz, MD
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Ohio State University College of Medicine, Columbus, OH

Chest. 2015;148(4_MeetingAbstracts):751A. doi:10.1378/chest.2278977
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SESSION TITLE: Obstructive Lung Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: COPD is a slowly progressive disease and frequent pneumonias are known to accelerate progression. We present an unusual case of a patient with severe emphysema whose FEV1, lung volumes and gas exchange improved following recurrent pneumonia, without lung volume reduction surgery.

CASE PRESENTATION: A 54 years-old female with severe air-flow obstruction and marked air-trapping was evaluated at our institution in April 2007 for LVRS, but was deemed not a candidate because of a homogeneous distribution of her emphysema.Two-months after evaluation she developed pseudomonas pneumonia with extensive involvement of her right lung. Her course was complicated by prolonged respiratory failure requiring tracheostomy and pneumothorax with prolonged air-leak.The patient was discharged after 2-month hospital stay and had gradual improvement in her respiratory status over 3-years, despite three additional hospital admissions for pneumonia over that time period. In December 2009 she had repeat pulmonary function studies performed which showed a dramatic improvement in her FEV1, lung volumes and arterial blood gases(Table1).By March 2010 she was able to be weaned off of oxygen.Her imaging studies showed fibrotic changes and decreased lung volume compared to her baseline studies which demonstrated marked hyperinflation and diaphragm flattening(Fig.1).

DISCUSSION: Evidence suggests that COPD exacerbations are associated with an excess decline in FEV1.However our patient showed significant improvement in FEV1 and oxygenation over time despite repeated pneumonia.These findings are likely due to fibrotic changes and a decrease in hyperinflation as a result of scarring and remodeling following recurrent infection.It is known that LVRS improves spirometry, lung volumes and symptoms.However it is major surgery associated with significant morbidity.There has been a continued effort to develop safe and effective non-surgical techniques.In recent years, evidence suggests that biologic lung reduction may be a feasible and safe technique.This case supports the concept that biologic agents can potentially reduce lung volumes by triggering structural changes.

CONCLUSIONS: This case demonstrates improved lung function following recurrent pneumonia in a patient with severe emphysema. We believe this example provides important insight for the continued search of effective non-surgical LVR methods.

Reference #1: Vestbo J et al.N Engl J Med 2011;365:1184-92.

Reference #2: Fishman A et al.N Engl J Med 2003;348(21):2059.

Reference #3: Refaely Y et al.Eur Respir J.2010;36(1):20.

DISCLOSURE: The following authors have nothing to disclose: Yihenew Negatu, Philip Diaz

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