Serial Lung Function and Elastic Recoil 2 Years After Lung Volume Reduction Surgery for Emphysema

¹ From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, University of California, Los Angeles, School of Medicine, University of California, Irvine
² From the School of Medicine, University of Toronto, Orange, Calif
³ From the University of California, Los Angeles, School of Medicine
⁴ From the School of Medicine, University of Toronto, Faculty of Medicine, Chapman Medical Center, Orange, Calif
⁵ From the Department of Radiology, Lakewood Regional Medical Center

Study objective: To evaluate serial lung function studies, including elastic recoil, in patients with severe emphysema who undergo lung volume reduction surgery (LVRS). To determine mechanism(s) responsible for changes in airflow limitation.

Methods: We studied 12 (10 male) patients aged 68±9 years (mean±SD) 6 to 12 months prior to and at 6-month intervals for 2 years after thoracoscopic bilateral LVRS for emphysema.

Results: At 2 years post-LVRS, relief of dyspnea remained improved in 10 of 12 patients, and partial or full-time oxygen dependency was eliminated in 2 of 7 patients. There was significant reduction in total lung capacity (TLC) compared with pre-LVRS baseline, 7.8±0.6 L (mean±SEM) (133±5% predicted) vs 8.6±0.6 L (144±5% predicted) (p=0.003); functional residual capacity, 5.6±0.5 L (157±9% predicted) vs 6.7±0.5 L (185±10% predicted) (p=0.001); and residual volume, 4.9±0.5 L (210±16% predicted) vs 6.0±0.5 L (260±13% predicted) (p=0.000). Increases were noted in FEV₁, 0.88±0.08 L (37±6% predicted) vs 0.72±0.05 L (29±3% predicted) (p=0.02); diffusing capacity, 8.5±1.0 mL/min/mm Hg (43±3% predicted) vs 4.2±0.7 mL/min/mm Hg (18±3% predicted) (p=0.001); static lung elastic recoil pressure at TLC (Pstat), 13.7±0.5 cm H₂O vs 11.3±0.6 cm H₂O (p=0.008); and maximum oxygen consumption, 8.7±0.8 mL/min/kg vs 6.9±1.5 mL/min/kg (p=0.03). Increase in FEV₁ correlated with the increase in TLC Pstat/TLC (r=0.75, p=0.03), but not with any baseline parameter.

Conclusion: Two years post-LVRS, there is variable clinical and physiologic improvement that does not correlate with any baseline parameter. Increased lung elastic recoil appears to be the primary mechanism for improved airflow limitation.

Key Words: elastic recoil • emphysema • lung function • lung volume reduction surgery

Submitted on October 22, 1997
Accepted on February 6, 1998

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