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LVRS beneficial for emphysema patients.

Patients with advanced emphysema who undergo lung volume reduction surgery fare better at 6 months than do those who have medical treatment alone, according to the results of two similar multicenter trials.

In a metaanalysis of the Canadian Lung Volume Reduction study (CLVR) and the Overholt-Blue Cross Emphysema Surgery Trial (OBEST), lung volume reduction surgery (LVRS) improved quality of life, symptoms of dyspnea, pulmonary function, and exercise tolerance.

"The present study provides information from the second-largest population available in the medical literature about randomized trials on LVRS," said principal author John D. Miller, M.D., of McMaster University, Hamilton, Ont.

Of the 93 patients in the two trials, 54 were randomized to LVRS and 39 to medical treatment, including pulmonary rehabilitation, smoking cessation, yearly vaccination, and oxygen therapy, as well as therapy with bronchodilators, corticosteroids, and antibiotics (Chest 2005;127:1166-77).

At 6 months, mortality was similar in the surgical and medical groups (5.6% vs. 5.1%, respectively). Compared with the medical group, those who underwent surgery had a higher forced expiratory volume in 1 second (167 mL), lower residual volume (-1,342 mL), lower total lung capacity (-1,044 mL), and greater 6-minute walking distance (148.8 feet).

The surgery group scored better on each segment of the chronic respiratory disease questionnaire than did the medical group. Scores on the physical component scale of the Medical Outcomes Study 36-item short form favored the surgical group.

LVRS "is a high-risk operation," the researchers noted. The achievement of optimal results "requires pulmonologists and thoracic surgeons who have adequate experience with performing LVRS."


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Article Details
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Title Annotation:Pulmonary Medicine; Lung Volume Reduction study
Author:Brunk, Doug
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Jul 1, 2005
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