title: Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony.
abstract: BACKGROUND
  Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known.
  
  
  METHODS
  We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months after LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen [Vab]) and phase shift angles (θ) calculated for the asynchrony between Vrc,p and Vrc,a (θRC), and between Vrc,a and Vab (θDIA).
  
  
  RESULTS
  Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°). Between-group difference in the change in θRC and θDIA during quiet breathing following treatment was 44.3° (95% CI, -78 to -10.6; P = .003) and 34.5° (95% CI, 1.4 to 67.5; P = .007) toward 0° (representing perfect synchrony), respectively, favoring the LVR group. Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.
  
  
  CONCLUSIONS
  Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England; Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. Electronic address: zzoumot@doctors.org.uk.
authors: Zaid
authors: Z
authors: Zoumot
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
authors: Antonella
authors: A
authors: LoMauro
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
authors: Andrea
authors: A
authors: Aliverti
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
authors: Christopher
authors: C
authors: Nelson
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England.
authors: Simon
authors: S
authors: Ward
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England.
authors: Simon
authors: S
authors: Jordan
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England.
authors: Michael I
authors: MI
authors: Polkey
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England.
authors: Pallav L
authors: PL
authors: Shah
authors: National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England.
authors: Nicholas S
authors: NS
authors: Hopkinson
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010992:Plethysmography, Impedance; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D012115:Residual Volume / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology*; D035441:Thoracic Wall / Q000503:physiopathology*; D016896:Treatment Outcome
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