Lung Surgery May Help With Emphysema


Thursday, July 27th 2000, 12:00 am
By: News On 6


A risky surgery to remove part of the damaged lungs of emphysema patients appears to at least temporarily improve their ability to breathe, walk and lead more normal lives, a small study found.

While a few thousand people with severe emphysema have had the operation and reported substantial improvement, Medicare and private insurers won't pay for it without proof it works better than standard medical care.

This study of ``lung-volume reduction surgery,'' and a much larger federal study under way, could change that.

``We're claiming a short-term benefit and hoping that will also bring a long-term benefit,'' said lead researcher Dr. Duncan Geddes, a professor of respiratory medicine at London's Royal Brompton Hospital. ``When it succeeds ... the effect on a person's life is really quite astonishing.''

Some patients who have had the surgery have been able to resume activities such as shopping, even golf, he said.

Emphysema is an incurable lung disease affecting 2 million Americans, with an estimated annual cost of $2.5 billion. Severe emphysema kills 30 percent of patients within in a year and 95 percent within 10 years.

Caused by smoking, genetic flaws or exposure to hazardous fumes, emphysema damages the lungs' air sacs, trapping air and destroying the airways' elasticity and structural support. That makes it hard to inflate and deflate the lungs, causing progressive shortness of breath that leaves patients unable to work, and eventually makes walking or other physical effort too difficult. Patients feel as if their lungs, enlarged by the disease, are too full to inhale or exhale much air.

Removing up to 30 percent of the lungs so they fit better inside the ribs makes it easier to inhale and exhale. The surgery works best if some tissue is undamaged.

``Ideally, you want (the emphysema) bad in patches and good in patches and then you take away the bad bits,'' Geddes said.

The surgery was tried — disastrously — in the 1950s, then resumed in the last decade after advances in postoperative care and development of sealants for air leaks improved survival after surgery, said Dr. Mark Lavietes, director of the pulmonary function lab at the University of Medicine and Dentistry of New Jersey in Newark.

The British study appears in Thursday's New England Journal of Medicine.

The surgery was performed on 23 patients, while a comparison group of 24 got standard medical care: a smoking-cessation program, several types of medication, vaccinations to prevent a dangerous pneumonia or flu infection, physical and occupational therapy, and supplemental oxygen.

Various tests of patients' lung function and sense of well-being found the surgical patients, on average, did better than the medical care group on several measures for three months to a year.

When each patient's original scores were compared with their scores at three, six and 12 months, the surgical group had big improvements in several key tests of lung function, while the medical group declined steadily.

Altogether, five patients who had the surgery — and three who underwent the standard regimen — died during the study. Also, five patients who had the surgery didn't benefit.

Lavietes, who was not involved in the study, noted that improvements in how well the patients' lungs got oxygen into their blood declined over time — while the measure improving most was the subjective one, how well patients felt and could perform daily activities. He said that could be a placebo effect.

However, Geddes said that doesn't mean the surgery isn't worthwhile.

``If they are actually doing more and feeling happier, whatever way it came about, that's what we wanted,'' he said.

A much larger study with 2,500 patients is under way. The lead researcher, Dr. Gail Weinmann of the National Heart, Lung and Blood Institute, expects results by 2004.

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On the Net: New England Journal of Medicine: http://www.nejm.org

National Emphysema Treatment Trial site: http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm