Chronic Obstructive Lung Disease - Surgical Procedures

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Outcomes. About 38% of lung transplants involve both lungs. Transplanting both lungs as opposed to just one significantly improves survival rates in patients under age 60. The average survival in patients who have both lungs transplanted is 6.41 years, compared to 4.59 years in patients with a single-lung transplant.

Lung Volume-Reduction Surgery

In lung volume-reduction surgery (LVRS), more than 30% of severely diseased lung tissue is removed, and the remaining parts of the lung are joined together. Breathing improvements after surgery are mainly due to the following factors:

• Improvement in the ability of the lung and chest wall to spring back during breathing
• Improvement in the function of the muscles, such as the diaphragm, involved with breathing

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Prognosis. The largest study to date, called the National Emphysema Treatment Trial (NETT), compared surgery to medical therapy. This study found that patients whose emphysema was in the upper lobes of the lungs and who had poor exercise ability (poor lung function) before surgery were more likely to benefit from surgery. These benefits included an increased chance of being alive 5 years after the surgery, an improved exercise ability, fewer symptoms, and a better quality of life.

In successful cases, the improvement is most notable within the first 6 months, after which the condition begins to get worse again. After 3 years, lung function deteriorates to the same level as it was before the procedure. LVRS is substantially more expensive than medical treatment.

Possible Candidates. The procedure is used only in people with severe emphysema, and in some people who have alpha-1 antitrypsin deficiency. It is not used for those with chronic bronchitis. Appropriate candidates with alpha-1 antitrypsin deficiency (even if they have disease in the lower lobe) may do well, but the procedure is only useful in a minority of these patients. Candidates must have the following characteristics:

• Under age 75
• Poor lung function (FEV1 less than 40% but higher than 20% of predicted)
• Carbon monoxide diffusing capacity of more than 20% of predicted
• Hyperinflated lungs (total lung capacity greater than 120% of predicted), generally with involvement of the upper lungs