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Comparison of Lung Volume Reduction Surgery and Physical Training on Health Status and Physiologic Outcomes^*

A Randomized Controlled Clinical Trial

^* From the Department of Pulmonary Medicine (Dr. Hillerdal), Karolinska Hospital, Stockholm; Pulmonary Department (Dr. Löfdahl), University Hospital, Lund; Pulmonary Department (Dr. Ström), University Hospital, Umeå; Pulmonary Department (Dr. Skoogh), Sahlgrenska University Hospital, Gothenburg; Department of Pulmonary Physiology (Dr. Jorfeldt), Karolinska Hospital, Stockholm; the Department of Thoracic Surgery (Dr. Nilsson), Sahlgrenska University Hospital, Gothenburg; and Department of Thoracic Surgery (Mr. Forslund-Stiby, Dr. Ranstam, and Dr. Gyllstedt), University Hospital, Lund.

Correspondence to: Gunnar Hillerdal, MD, FCCP, Department of Pulmonary Medicine, Karolinska Hospital, S-171 76 Stockholm, Sweden; e-mail: gunnar.hillerdal{at}karolinska.se

Study objectives: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements.

Design: After an initial 6-week physical training program, researchers’ patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year.

Setting: All seven thoracic surgery centers in Sweden.

Patients: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS.

Interventions: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively.

Measurements and results: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV₁, residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months.

Conclusions: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.

Key Words: emphysema • health status • lung function • Medical Outcomes Study Short-Form General Health Survey • St. George Respiratory Questionnaire