Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease.
OBJECTIVE
This review describes the role of lung volume reduction surgery (LVRS) for the management of refractory dyspnea and other debilitating conditions in patients with chronic obstructive pulmonary disease. Recent studies, including a randomized trial comparing LVRS to medical therapy, are analyzed.


RESULTS
LVRS plus optimal medical therapy is superior to medical therapy alone in treating certain subsets of patients with severe emphysema. In patients with predominantly upper lobe emphysema and low-exercise capacity, LVRS not only improves symptoms of dyspnea and exercise intolerance, but also is associated with improved survival. Furthermore, LVRS has recently been shown to be superior to medical therapy in improving other quality of life parameters, such as nutritional status, sleep quality, and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe emphysema.


CONCLUSIONS
LVRS is an effective strategy in the treatment of properly selected patients with COPD, improving survival and quality of life, including exercise tolerance, dyspnea, oxygen requirement and functional status.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Asad A
AA
Shah
Thomas A
TA
D'Amico
D003362:Cost-Benefit Analysis; D004417:Dyspnea / Q000191:economics / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology*; D011788:Quality of Life / Q000523:psychology