title: Serial lung function and elastic recoil 2 years after lung volume reduction surgery for emphysema.
abstract: OBJECTIVE
  To evaluate serial lung function studies, including elastic recoil, in patients with severe emphysema who undergo lung volume reduction surgery (LVRS). To determine mechanism(s) responsible for changes in airflow limitation.
  
  
  METHODS
  We studied 12 (10 male) patients aged 68+/-9 years (mean+/-SD) 6 to 12 months prior to and at 6-month intervals for 2 years after thoracoscopic bilateral LVRS for emphysema.
  
  
  RESULTS
  At 2 years post-LVRS, relief of dyspnea remained improved in 10 of 12 patients, and partial or full-time oxygen dependency was eliminated in 2 of 7 patients. There was significant reduction in total lung capacity (TLC) compared with pre-LVRS baseline, 7.8+/-0.6 L (mean+/-SEM) (133+/-5% predicted) vs 8.6+/-0.6 L (144+/-5% predicted) (p=0.003); functional residual capacity, 5.6+/-0.5 L (157+/-9% predicted) vs 6.7+/-0.5 L (185+/-10% predicted) (p=0.001); and residual volume, 4.9+/-0.5 L (210+/-16% predicted) vs 6.0+/-0.5 L (260+/-13% predicted) (p=0.000). Increases were noted in FEV1, 0.88+/-0.08 L (37+/-6% predicted) vs 0.72+/-0.05 L (29+/-3% predicted) (p=0.02); diffusing capacity, 8.5+/-1.0 mL/min/mm Hg (43+/-3% predicted) vs 4.2+/-0.7 mL/min/mm Hg (18+/-3% predicted) (p=0.001); static lung elastic recoil pressure at TLC (Pstat), 13.7+/-0.5 cm H2O vs 11.3+/-0.6 cm H2O (p=0.008); and maximum oxygen consumption, 8.7+/-0.8 mL/min/kg vs 6.9+/-1.5 mL/min/kg (p=0.03). Increase in FEV1 correlated with the increase in TLC Pstat/TLC (r=0.75, p=0.03), but not with any baseline parameter.
  
  
  CONCLUSIONS
  Two years post-LVRS, there is variable clinical and physiologic improvement that does not correlate with any baseline parameter. Increased lung elastic recoil appears to be the primary mechanism for improved airflow limitation.
authors.affiliation: Department of Medicine, Lakewood Regional Medical Center, University of California, Los Angeles, School of Medicine, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Gelb
authors.forename: M
authors.initials: M
authors.lastname: Brenner
authors.forename: R J
authors.initials: RJ
authors.lastname: McKenna
authors.forename: R
authors.initials: R
authors.lastname: Fischel
authors.forename: N
authors.initials: N
authors.lastname: Zamel
authors.forename: M J
authors.initials: MJ
authors.lastname: Schein
mesh_terms: D000368:Aged; D000403:Airway Resistance; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D004548:Elasticity; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000601:surgery*; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D011653:Pulmonary Diffusing Capacity; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics