| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
Study objective: To explore mechanisms of relief of exertional breathlessness following surgery to reduce thoracic gas volume in patients with emphysema.
Materials and methods: We studied 8 patients with emphysema (FEV1=39±3% predicted; residual volume [RV]=234±12% predicted; mean±SEM) who were severely breathless despite optimal pharmacotherapy and who underwent unilateral bullectomy for giant bullae (greater than one third hemithorax); 4 of these also had ipsilateral lung reduction (pneumectomy). Pulmonary function and cycle exercise performance (n=6) were evaluated before and 13±3 weeks after surgery. Chronic breathlessness was measured with the Baseline Dyspnea Index and the Medical Research Council dyspnea scale. Exertional breathlessness was measured using Borg ratings at a standardized work rate (BorgsTD).
Results: FEV1, FVC, and maximal inspiratory pressures increased postsurgery by 29±7% (p<0.05), 24±10% (p=0.06), and 39±12% (p<0.01), respectively. Plethysmographic total lung capacity, RV, and functional residual capacity fell by 14±2%, 30±4%, and 18±3%, respectively (p<0.001). All measures of chronic breathlessness improved significantly (p<0.05). During exercise at a standardized work rate, BorgsTD fell 45% (p<0.05), end-expiratory lung volume (EELV) fell 22% (p<0.01), and breathing frequency (F) fell 25% (p=0.08). By multiple stepwise regression analysis, 99% (p=0.007) of the variance in symptom relief (
BorgsTD) was explained by the combination of decreased ratio of the end-expiratory lung volume to total lung capacity, decreased F, and diminished mechanical constraints on tidal volume (tidal volume to vital capacity ratio).
Conclusion: Reduced exertional breathlessness at a given workload after volume reduction surgery was attributed to a combination of reduced thoracic hyperinflation, reduced F, and reduced mechanical constraints on lung volume expansion.
Key Words: breathlessness • bullectomy • emphysema • exercise • pneumectomy
Submitted on January 11, 1996
Accepted on April 12, 2007
This article has been cited by other articles:
|
|
 |
|
  R. Neviere, M. Catto, N. Bautin, S. Robin, H. Porte, J. Desbordes, and R. Matran Longitudinal changes in hyperinflation parameters and exercise capacity after giant bullous emphysema surgery. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1203 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Vogiatzis, O Georgiadou, S Golemati, A Aliverti, E Kosmas, E Kastanakis, N Geladas, A Koutsoukou, S Nanas, S Zakynthinos, et al. Patterns of dynamic hyperinflation during exercise and recovery in patients with severe chronic obstructive pulmonary disease Thorax, September 1, 2005; 60(9): 723 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. S.H. Ng and A. P.C. Yim Video-assisted thoracoscopic surgery (VATS) bullectomy for emphysematous/bullous lung disease MMCTS, April 25, 2005; 2005(0425): 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z J McKeoughl, J A Alison, M S Bayfield, and P T.P Bye Supported and unsupported arm exercise capacity following lung volume reduction surgery: a pilot study Chronic Respiratory Disease, April 1, 2005; 2(2): 59 - 65. [Abstract] [PDF]
|
|
|
|
 |
|
 N. S. Hopkinson, T. P. Toma, D. M. Hansell, P. Goldstraw, J. Moxham, D. M. Geddes, and M. I. Polkey Effect of Bronchoscopic Lung Volume Reduction on Dynamic Hyperinflation and Exercise in Emphysema Am. J. Respir. Crit. Care Med., March 1, 2005; 171(5): 453 - 460. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. A. Calverley and N. G. Koulouris Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology Eur. Respir. J., January 1, 2005; 25(1): 186 - 199. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Appleton, R. Adams, S. Porter, M. Peacock, and R. Ruffin Sustained Improvements in Dyspnea and Pulmonary Function 3 to 5 Years After Lung Volume Reduction Surgery Chest, June 1, 2003; 123(6): 1838 - 1846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Yusen, S. S. Lefrak, D. S. Gierada, G. E. Davis, B. F. Meyers, G. A. Patterson, and J. D. Cooper A Prospective Evaluation of Lung Volume Reduction Surgery in 200 Consecutive Patients Chest, April 1, 2003; 123(4): 1026 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.A. Neder, S. Dal Corso, C. Malaguti, S. Reis, M.B. De Fuccio, H. Schmidt, J.P. Fuld, and L.E. Nery The pattern and timing of breathing during incremental exercise: a normative study Eur. Respir. J., March 1, 2003; 21(3): 530 - 538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
ATS/ACCP Statement on Cardiopulmonary Exercise Testing Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 211 - 277. [Full Text] [PDF]
|
|
|
|
|
|
T. C. Mineo, V. Ambrogi, E. Pompeo, P. Bollero, D. Mineo, and I. Nofroni Body weight and nutritional changes after reduction pneumoplasty for severe emphysema: A randomized study J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 660 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. De Giacomo, E. A. Rendina, F. Venuta, M. Moretti, E. Mercadante, I. Mohsen, M.-J. Filice, and G. F. Coloni Bullectomy is comparable to lung volume reduction in patients with end-stage emphysema Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 357 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Shamji, D. E. Maziak, F. M. Shamji, F. R.K. Matzinger, and D. G. Perkins Surgical staple metalloptysis after apical bullectomy: a reaction to bovine pericardium? Ann. Thorac. Surg., July 1, 2002; 74(1): 258 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Fujimoto, H. Teschler, L. Hillejan, G. Zaboura, and G. Stamatis Long-term results of lung volume reduction surgery Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 483 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Homan, S. Porter, M. Peacock, N. Saccoia, A. M. Southcott, and R. Ruffin Increased Effective Lung Volume Following Lung Volume Reduction Surgery in Emphysema Chest, October 1, 2001; 120(4): 1157 - 1162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. GELB, R. J. McKENNA Jr., M. BRENNER, J. D. EPSTEIN, and N. ZAMEL Lung Function 5 yr after Lung Volume Reduction Surgery for Emphysema Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1562 - 1566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Gelb, R. J. McKenna Jr, and M. Brenner Expanding Knowledge of Lung Volume Reduction Chest, May 1, 2001; 119(5): 1300 - 1303. [Full Text] [PDF]
|
|
|
|
|
|
M. CASSART, J. HAMACHER, Y. VERBANDT, S. WILDERMUTH, D. RITSCHER, E. W. RUSSI, P. de FRANCQUEN, M. CAPPELLO, W. WEDER, and M. ESTENNE Effects of Lung Volume Reduction Surgery for Emphysema on Diaphragm Dimensions and Configuration Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1171 - 1175. [Abstract] [Full Text]
|
|
|
|
|
|
E. Pompeo, M. Marino, I. Nofroni, G. Matteucci, and T. C. Mineo Reduction pneumoplasty versus respiratory rehabilitation in severe emphysema: a randomized study Ann. Thorac. Surg., September 1, 2000; 70(3): 948 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Suga, T. Tsukuda, H. Awaya, N. Matsunaga, K. Sugi, and K. Esato Interactions of Regional Respiratory Mechanics and Pulmonary Ventilatory Impairment in Pulmonary Emphysema : Assessment With Dynamic MRI and Xenon-133 Single-Photon Emission CT Chest, June 1, 2000; 117(6): 1646 - 1655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. O'Donnell Assessment of Bronchodilator Efficacy in Symptomatic COPD : Is Spirometry Useful? Chest, February 1, 2000; 117(2_suppl): 42S - 47S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Serna, M. Brenner, K. E. Osann, R. J. McKenna Jr, J. C. Chen, R. J. Fischel, B. U. Jones, A. F. Gelb, and A. F. Wilson SURVIVAL AFTER UNILATERAL VERSUS BILATERAL LUNG VOLUME REDUCTION SURGERY FOR EMPHYSEMA J. Thorac. Cardiovasc. Surg., December 1, 1999; 118(6): 1101 - 1109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lahrmann, M. Wild, T. Wanke, E. Tschernko, W. Wisser, W. Klepetko, and H. Zwick Neural Drive to the Diaphragm After Lung Volume Reduction Surgery* Chest, December 1, 1999; 116(6): 1593 - 1600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Gelb, R. J. McKenna Jr., M. Brenner, M. J. Schein, N. Zamel, and R. Fischel Lung Function 4 Years After Lung Volume Reduction Surgery for Emphysema* Chest, December 1, 1999; 116(6): 1608 - 1615. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hamacher, K. E. Bloch, U. Stammberger, R. A. Schmid, I. Laube, E. W. Russi, and W. Weder Two years’ outcome of lung volume reduction surgery in different morphologic emphysema types Ann. Thorac. Surg., November 1, 1999; 68(5): 1792 - 1798. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wisser, W. Klepetko, O. Senbaklavaci, T. Wanke, E. Gruber, E. Tschernko, and E. Wolner Chronic hypercapnia should not exclude patients from lung volume reduction surgery Eur. J. Cardiothorac. Surg., August 1, 1999; 14(2): 107 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. O'DONNELL, M. LAM, and K. A. WEBB Spirometric Correlates of Improvement in Exercise Performance after Anticholinergic Therapy in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 542 - 549. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Lando, P. Boiselle, D. Shade, J. M. Travaline, S. Furukawa, and G. J. Criner Effect of Lung Volume Reduction Surgery on Bony Thorax Configuration in Severe COPD Chest, July 1, 1999; 116(1): 30 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. De Giacomo, F. Venuta, E. A. Rendina, G. Della Rocca, A. M. Ciccone, C. Ricci, and G. Furio Coloni Video-assisted thoracoscopic treatment of giant bullae associated with emphysema Eur. J. Cardiothorac. Surg., June 1, 1999; 15(6): 753 - 757. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Chen, D. L. Serna, M. Brenner, L. L. Powell, J. Huh, R. McKenna Jr, R. J. Fischel, A. Gelb, J. Monti, T. Burney, et al. DIFFUSING CAPACITY LIMITATIONS OF THE EXTENT OF LUNG VOLUME REDUCTION SURGERY IN AN ANIMAL MODEL OF EMPHYSEMA J. Thorac. Cardiovasc. Surg., April 1, 1999; 117(4): 728 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. O'Brien, S. Furukawa, A. M. Kuzma, F. Cordova, and G. J. Criner Improvements in Lung Function, Exercise, and Quality of Life in Hypercapnic COPD Patients After Lung Volume Reduction Surgery Chest, January 1, 1999; 115(1): 75 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Meek Dyspnea . Mechanisms, Assessment, and Management: A Consensus Statement Am. J. Respir. Crit. Care Med., January 1, 1999; 159(1): 321 - 340. [Full Text]
|
|
|
|
|
|
E. M. TSCHERNKO, E. M. GRUBER, P. JAKSCH, O. JANDRASITS, U. JANTSCH, T. BRACK, H. LAHRMANN, W. KLEPETKO, and T. WANKE Ventilatory Mechanics and Gas Exchange during Exercise before and after Lung Volume Reduction Surgery Am. J. Respir. Crit. Care Med., November 1, 1998; 158(5): 1424 - 1431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. O'DONNELL, M. LAM, and K. A. WEBB Measurement of Symptoms, Lung Hyperinflation, and Endurance during Exercise in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., November 1, 1998; 158(5): 1557 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. T. FERGUSON, E. FERNANDEZ, M. R. ZAMORA, M. POMERANTZ, J. BUCHHOLZ, and B. J. MAKE Improved Exercise Performance Following Lung Volume Reduction Surgery for Emphysema Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1195 - 1203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wisser, W. Klepetko, M. Kontrus, A. Bankier, O. Senbaklavaci, A. Kaider, T. Wanke, E. Tschernko, and E. Wolner Morphologic Grading of the Emphysematous Lung and Its Relation to Improvement After Lung Volume Reduction Surgery Ann. Thorac. Surg., March 1, 1998; 65(3): 793 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Huh, M. Brenner, J. C. Chen, B. Yoong, A. Gassel, F. Katie, J. C. Milliken, R. McKenna, Jr., R. J. Fischel, A. Gelb, et al. Changes In Pulmonary Physiology After Lung Volume Reduction Surgery In A Rabbit Model Of Emphysema J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 328 - 335. [Abstract] [Full Text]
|
|
|
|
|
|
C. A. KELLER, G. RUPPEL, A. HIBBETT, J. OSTERLOH, and K. S. NAUNHEIM Thoracoscopic Lung Volume Reduction Surgery Reduces Dyspnea and Improves Exercise Capacity in Patients with Emphysema Am. J. Respir. Crit. Care Med., July 1, 1997; 156(1): 60 - 67. [Abstract] [Full Text]
|
|
|
|
|
|
J. O. BENDITT, S. LEWIS, D. E. WOOD, L. KLIMA, and R. K. ALBERT Lung Volume Reduction Surgery Improves Maximal O2 Consumption, Maximal Minute Ventilation, O2 Pulse, and Dead Space-to-Tidal Volume Ratio during Leg Cycle Ergometry Am. J. Respir. Crit. Care Med., July 1, 1997; 156(2): 561 - 566. [Abstract] [Full Text]
|
|
|
|
|
|
M. D. BECKER, Y. M. BERKMEN, J. H. M. AUSTIN, I. K. MUN, B. M. ROMNEY, A. ROZENSHTEIN, P. A. JELLEN, C. K. YIP, B. THOMASHOW, and M. E. GINSBURG Lung Volumes before and after Lung Volume Reduction Surgery . Quantitative CT Analysis Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1593 - 1599. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
