The Effect of Lung Volume Reduction Surgery on Chronic Obstructive Pulmonary Disease Exacerbations
Year: 2007
Type: article
Abstract: RATIONALE: Lung volume reduction surgery (LVRS) has been demonstrated to provide a functional and mortality benefit to a select group of subjects with chronic obstructive pulmonary disease (COPD). The effect of LVRS on COPD exacerbations has not been as extensively studied, and whether improvement in postoperative lung function alters the risk of disease exacerbations is not known. OBJECTIVES: To examine the effect, and mechanism of potential benefit, of LVRS on COPD exacerbations by comparing the medical and surgical cohorts of the National Emphysema Treatment Trial (NETT). METHODS: A COPD exacerbation was defined using Centers for Medicare and Medicaid Services data and International Classification of Diseases, Ninth Revision, discharge diagnosis. MEASUREMENTS AND MAIN RESULTS: There was no difference in exacerbation rate or time to first exacerbation between the medical and surgical cohorts during the year before study randomization (P = 0.58 and 0.85, respectively). Postrandomization, the surgical cohort experienced an approximate 30% reduction in exacerbation frequency (P = 0.0005). This effect was greatest in those subjects with the largest postoperative improvement in FEV(1) (P = 0.04) when controlling for changes in other spirometric measures of lung function, lung capacities, and room air arterial blood gas tensions. Finally, LVRS increased the time to first exacerbation in both those subjects with and those without a prior history of exacerbations (P = 0.0002 and P < 0.0001, respectively). CONCLUSIONS: LVRS reduces the frequency of COPD exacerbations and increases the time to first exacerbation. One explanation for this benefit may be the postoperative improvement in lung function.
Institutions: Brigham and Women's Hospital, Harvard University, University of Washington, VA Puget Sound Health Care System, Fred Hutch Cancer Center, Cedars-Sinai Medical Center, University of Michigan, National Jewish Health, University of Pittsburgh, Temple University, Cleveland Clinic, Beth Israel Deaconess Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Brigham and Women's Hospital, University of Pennsylvania, Ohio State University, Mayo Foundation for Medical Education and Research, Cleveland Clinic, Cleveland Clinic Foundation, Saint Louis University, Temple University, Cedars-Sinai Medical Center, National Institutes of Health, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, University of California, San Diego, National Heart, Lung, and Blood Institute
Awards: CLINICAL CENTER FOR THE LUNG VOLUME REDUCTION SURGERY, G1207659464, G1220799682, LUNG VOLUME REDUCTION STUDY--CLINICAL CENTER, G1439225947, G1576662596, G1615620936, CLINICAL CENTER FOR LVRS, G1735610881, CLNICAL CENTER FOR LVRS, CLNICAL CENTER FOR LVRS, G182694510, LUNG VOLUME REDUCTION STUDY--CLINICAL CENTER, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, G2412257637, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, G2599011918, G278468722, G3110798224, CLINICAL COORDINATING CENTER FOR LVRS, G3805264881, G4153249725, G4255341634, G48533833, Genetic and Environmental Factors Affecting COPD Exacerbations, G556935766, G6315211796, CLNICAL CENTER FOR THE LVRS, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, CLINICAL CENTER FOR LVRS, CLINICAL CENTER FOR THE LUNG VOLUME REDUCTION SURGERY, G778147052, COPD Exacerbations: Pharmacogenetic Approaches to Therapy, LUNG VOLUME REDUCTION SURGERY--CLINICAL CENTER, Integrated Training in Respiratory Research, CLINICAL CENTER FOR THE LUNG VOLUME REDUCTION SURGERY, CLINICAL CENTER FOR THE LUNG VOLUME REDUCTION SURGERY
OpenAlex ID: W2054685659