Will Lung Volume Reduction Surgery Help Me?

Dear Dr. Mahler: I have been reading about lung volume reduction clinical trials. Is this procedure for people with emphysema that is diffuse? Thank you. Karen from Cranston, Rhode Island Dear Karen: Lung volume reduction surgery (abbreviated LVRS) is an operation to remove about 20 – 30% of damaged lung for those with severe emphysema. By removing some areas of the lung that are not working normally, the remaining lung can expand and be more efficient. The operation is performed either by a large incision in the chest (called thoracotomy) or by several small incisions using a scope to do the surgery (called video-assisted thorascopic surgery and abbreviated VATS). The evaluation process is extensive to determine whether you are a “good candidate” for LVRS. It includes a medical history and physical examination, tests of how your heart and lungs function, an exercise test, and a CT scan of your chest. In one study, it was shown that those with the emphysema mainly in the upper parts of the lung and with low exercise tolerance benefited the most by having less breathing difficulty, a better quality of life, and improved ability to exercise after LVRS. You will be expected to join a pulmonary rehabilitation program for 6 – 8 weeks before surgery so that you are in the best possible shape. The surgeon will review with you the risks with this operation. Karen, by your question it sounds like you were told that you have diffuse emphysema on a CT scan. This means that the damage is throughout your lungs rather than predominantly in the upper lungs as is preferred for best results with LVRS. If this is the case, you may wish to consider another approach IF you continue to have breathing difficulty despite being treated with the best available medications for COPD and having completed pulmonary rehabilitation program. At certain medical centers, small devices such as coils or umbrellas are placed through a bronchoscope (small flexible tube) into an airway (breathing tube) that leads to an emphysema area. The purpose of the coil or umbrella is to collapse damaged lung so that the remaining lung can expand and function more normally. The procedure is called bronchoscopic lung volume reduction. At the present time, the placement of coil or umbrella devices has not been approved by the Food and Drug Administration (FDA) and is therefore investigational. This means you would need to be part of a study to evaluate the benefits and risks of placement of a coil or umbrella into your airway.
Photo of umbrella device taken from inside a breathing tube.  The umbrella will block air from entering the lung leading to collapse.

Photo of umbrella device taken from inside a breathing tube. The umbrella will block air from entering the lung leading to collapse.

View of umbrella devices positioned into breathing tubes that block entry of air into the lung tissue.

View of umbrella devices positioned into breathing tubes that block entry of air into the lung tissue.

I practice in New Hampshire and have referred interested patients with advanced emphysema to Dr. Adnan Majid, Director of the Emphysema Clinic at Beth Isreal Deaconess Medical Center in Boston, Massachusetts. Dr. Mahid and his team are participating in different FDA-approved clinical trials to learn about the benefits and safety of bronchoscopic lung volume reduction with the Nitinol coil (called the RENEW study) and the IBV umbrella valve (called the EMPROVE study). If you are interested, you should discuss this with your doctor, and possibly ask her/him to refer you to this medical center as it is close to where you live in Rhode Island.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.