Comparison of functional state between bilateral lung volume reduction surgery and pulmonary rehabilitation: a six-month followup study.
OBJECTIVE
The effectiveness of bilateral lung volume reduction surgery (BLVRS) in the improvement of functional state in severe chronic obstructive pulmonary disease (COPD) has not been reported. This study examined the effects of BLVRS on subjective and objective measures of functional state (FS) and compared these effects with those gained from pulmonary rehabilitation (PR).


METHODS
Twenty-eight consecutive patients were studied. Of 13 BLVRS and 15 PR patients enrolled in the study, 12 and 13 patients, respectively, completed the 6-month protocol. Pulmonary function (FEV1, FVC, and FEF25-75) was measured by spirometry. Subjective FS was measured with the activity component of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) and objective FS was determined as the 6-min walk distance (6mwD). Additionally, the maximal dyspnea intensity measured with the Borg scale during the 6-min test was recorded. All outcomes were recorded prior to, and six months following treatment.


RESULTS
In patients undergoing BLVRS, FEV1 and FVC increased (17.3% and 16.8%) while in those treated with PR alone, FEV1 and FVC decreased (7.6% and 16.1%,p < 0.05). The subjective functional state (PFSDQ) was also significantly different between BLVRS and PR alone (PFSDQ = -49.4% vs. +4.7%, p < 0.05). Although the absolute distance walked over 6 min did not reach statistical significance, the BLVRS group increased the distance by 20% while the PR alone group had a decrease (-28%). Both groups demonstrated a reduction in dyspnea with exercise but the volume reduction patients showed a significantly greater reduction (PR = -1.0; BLVRS = -2.6, p < 0.05).


CONCLUSIONS
BLVRS results in greater improvement in pulmonary function, dyspnea with exercise, and subjective FS when compared to PR 6 months after surgery.
Mercer
K
K
University of California, Davis Medical Center, Division of Pulmonary and Critical Care Medicine, School of Medicine, Sacramento 95817, USA.
Follette
D
D
Breslin
E
E
Allen
R
R
Hoso
A
A
Volz
B
B
Albertson
T
T
D000368:Aged; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery*; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014797:Vital Capacity; D016138:Walking