Improved lung function and quality of life following increased elastic recoil after lung volume reduction surgery in emphysema

Abstract

Lung volume reduction surgery for severe emphysema with removal of 20–30% of the most destroyed parts of the lung parenchyma has been reported to improve lung function substantially. Increased elastic recoil has been suggested as one underlying mechanism for the improvement. Fourteen patients, seven men and seven women with a mean age of 62 years, who underwent bilateral lung volume reduction surgery have been followed up for 3 months. We here report the data on quality of life, lung function and elastic recoil. FEV 1·0 increased by a mean of 26% from 0·58 1 to 0·73 1 ( P<0·01). The mean TLC was reduced by 16% from 8·9 1 to 7·5 1 ( P<0·001). The level of hyperinflation decreased as implied by a reduction in the ratio of RV to TLC from 0·70 to 0·60 ( P<0·001). The pulmonary elastic recoil improved, with an increase in the transpulmonary pressure at maximal inspiration ( Pe1 tlc) from 0·95 kPa to 1·35 kPa ( P<0·05) and an average increase in the coefficient of retraction Pe1 tlc/TLC) from 0·12 kPa 1 −1 to 0·19 kPa 1 −1 ( P<0·01). The resting PaO 2 increased from a mean of 8·7 kPa to 9·8 kPa ( P<0·01). The patients reported a high degree of subjective improvement according to the St. George's Respiratory Questionnaire and the working capacity on a bicycle increased by 26% from a mean of 38 W to 48 W ( P<0·01). The promising short-term results of lung volume reduction surgery for severe emphysema appear to be related to improved pulmonary elastic recoil.