Published ahead of print on October 25, 2007, doi:10.1164/rccm.200708-1194OC
Am. J. Respir. Crit. Care Med., Volume 177, Number 2, January 2008, 164-169
A more recent version of this article appeared on January 15, 2008
Submitted on August 13, 2007
Accepted on October 25, 2007
The Effect of Lung Volume Reduction Surgery on Chronic Obstructive Pulmonary Disease Exacerbations
George R Washko1*, Vincent S Fan2, Scott D Ramsey3, Zab Mohsenifar4, Fernando Martinez5, Barry J Make6, Frank C Sciurba7, Gerald J Criner8, Omar Minai9, Malcolm M DeCamp10, and John J Reilly1
1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,
2 University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Seattle, WA, USA,
3 University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
4 Cedars-Sinai Medical Center, Los Angeles, CA, USA,
5 University of Michigan, Ann Arbor, MI, USA,
6 National Jewish Medical and Research Center, Denver, CO, USA,
7 University of Pittsburgh, Pittsburgh, PA, USA,
8 Temple University, Philadelphia, PA, USA,
9 Cleveland Clinic Foundation, Cleveland, OH, USA,
10 Beth Israel Deaconess Medical Center, Boston, MA, USA
* To whom correspondence should be addressed. E-mail: Gwashko{at}Partners.org.
Rationale: Lung volume reduction surgery (LVRS) has been demonstrated to provide a functional and mortality benefit to a select group of subjects with Chronic Obstructive Pulmonary Disease (COPD). The effect of LVRS on COPD exacerbations has not been as extensively studied, and whether improvement in post-operative lung function alters the risk of disease exacerbations is not known.
Objectives: To examine the effect, and mechanism of potential benefit, of LVRS on COPD exacerbations by comparing the medical and surgical cohorts of the National Emphysema Treatment Trial (NETT).
Measurements and Main Results: A COPD exacerbation was defined using Centers for Medicare and Medicaid Services (CMS) data and ICD-9 discharge diagnosis. There was no difference in exacerbation rate or time to first exacerbation between the medical and surgical cohorts during the year prior to study randomization (p=0.58 and 0.85 respectively). Post randomization, the surgical cohort experienced an approximate 30% reduction in exacerbation frequency (P=0.0005). This effect was greatest in those subjects with the largest post-operative improvement in the forced expiratory volume in one second (FEV1) (p=0.04) when controlling for changes in other spirometric measures of lung function, lung capacities, and room air arterial blood gas tensions. Finally, LVRS increased the time to first exacerbation in both those subjects with and those without a prior history of exacerbations (P=0.0002 and P<0.0001 respectively).
Conclusions: LVRS reduces the frequency of COPD exacerbations and increases the time to first exacerbation. One explanation for this benefit may be the post-operative improvement in lung function.
www.clinicaltrials.gov NCT00000606
Key words: COPD, Exacerbation, LVRS
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