hLung Volume Reduction Surgery Proven Beneficial to Emphysema Patients

Lung volume reduction surgery (LVRS) may improve the quality of life and overall well-being in patients with severe emphysema, according to the National Emphysema Treatment Trial (NETT), the first study to randomize emphysema patients to receive LVRS or non-surgical medical care.

Researchers for NETT recruited 1,218 patients with severe emphysema and randomized them to either undergo LVRS or non-surgical medical treatment which consisted of customized use of medication, oxygen support, smoking cessation and pulmonary rehabilitation. Of the sampled population, 608 patients underwent LVRS and 610 received standard medical care. They were monitored for five years, or until a “composite event” (a serious decline in quality of life or death) occurred. The average time until such an event was one year for medically treated patients and two years for patients who underwent LVRS.

“We found lung reduction surgery is good treatment alternative for selected emphysema patients since it not only improves survival but also meaningfully improves quality of life for a period of at least five years after the operation,” said lead author of the study, Roberto Benzo, M.D., MSc., Mayo Clinic. “Patients who underwent LVRS, with the exception of those who had non-upper-lobe-predominant emphysema, had both a survival and quality of life benefit when compared to similar patients undergoing medical treatment only.”

For patients who received LVRS, a portion of the emphysematous lung tissue was removed to prevent “air-trapping,” where the patient can inhale but is unable to force the air back out of the lung.

“By removing the section of lung that is primarily affected with severe emphysema, we can decrease air trapping and consequently the shortness of breath, which can thereby improve the patient's perceived quality of life,” said Dr. Benzo.

Researchers caution that LVRS carries serious risks. In the study, nearly 5% of the patients who underwent LVRS died following surgery. However, once the post-operative period is over, the patients’ quality of life is improved immediately. Full Story

Cycling to Better Health

With the diagnosis of CPOD and associated breathing troubles, many patients often find that it is much more difficult to lead an active life. Difficulties with completely exhaling often mean the inability to stay active and physically fit.

Now, however, a series of studies from the Norwegian University of Science and Technology (NTNU) suggests that improving a patient’s overall fitness may actually improve their quality of life. Their solutions: additional oxygen during exercise or cycling on a stationary bicycle using just one leg at a time.

During exercise, the muscles place a demand on the lungs for oxygen, which in any other training environment would mean a positive workout. For COPD patients, however, the lungs may have such a difficult time providing the oxygen they need that the oxygen saturation in their blood may drop below 88%. By providing these patients with extra oxygen while they exercise, this crisis is averted and physical fitness can be achieved.

Participants in one study, who were given extra oxygen during exercise, demonstrated a 20% improvement in cardiovascular fitness after just 24 high-intensity training sessions. They also reported that their quality of life improved by 24% in terms of physical health status, and 35% in terms of mental health status.

By improving their fitness, COPD patients used less of their maximum capacity. That, in turn, made training less of an effort. Further, because the effort required to breathe was reduced, patients were less limited overall by CPOD.

For patients without access to oxygen during exercise, riding the bicycle one leg at a time is another solution. This approach maximizes the supply of oxygen to the muscles, while minimizing the effects of reduced lung capacity, essentially enabling the load on each leg to be increased without increasing the work the lungs must do. The results:  a 12% increase in whole body fitness and 23% increase in workout rate.

Ultimately, by improving fitness levels, COPD patients are better able to participate in social life and perform everyday tasks. As a result, quality of life is improved. Full Story

In Memoriam: Dr. Thomas L. Petty

National Emphysema Foundation loses close friend, early advocate

A world renowned pulmonologist and early supporter of and contributor to the National Emphysema Foundation, Dr. Thomas Petty, M.D., passed away Dec. 12, 2009 in Denver, CO following a lengthy illness.

As a medical student, Dr. Petty’s first patient was a man with emphysema, an experience that shaped his career as evidenced by his interest and later accomplishments in Chronic Obstructive Pulmonary Disease (COPD) and pulmonary/respiratory illness.

He is recognized as having completed the original research which resulted in the extensive use of home or ambulatory oxygen and, later, liquid oxygen. Dr. Petty is also considered responsible for the widespread use of oxygen therapy through his sponsorship of the Long Term Oxygen Therapy (LTOT) Consensus Conference, which was launched in 1986.

In addition to his work with respiratory patients, Dr. Petty is also a well-known author and editor of patient-focused books, most notably Enjoying Life with COPD (1985). He has published more than 750 articles in medical journals and authored or edited more than 40 books.

Dr. Petty wrote freely and openly to COPD patients about coping with the disease, encouraging them to enjoy life and embrace their future. In Enjoying Life with COPD, Dr. Petty wrote: “Remember that birth, life and death are natural phenomenon.”

Regarded as the “Father of Pulmonary Medicine,” Dr. Petty advanced every significant area of pulmonary disease and many areas in critical care and sleep medicine during his lifetime. He is also highly regarded for his work in identifying Adult Respiratory Distress Syndrome (ARDS).

Dr. Petty served on and led the board of the Pulmonary Education & Research Foundation and was the organizer and founding president of the Association of Pulmonary Program Directors. He founded a quarterly newsletter, Lung Cancer Frontiers, and co-founded the International Respiratory Care Club.  He served as president of the American College of Chest Physicians, was a board member of the COPD Foundation and a member of the National Emphysema Foundation’s medical advisory board for more than 30 years.

Dr. Petty also served as a professor of medicine at the University of Colorado Health Sciences Center in Denver and at Rush-Presbyterian-St. Luke’s Medical Center in Chicago. He was awarded the University of Colorado’s Silver and Gold Award for Excellence and earned a place in Colorado’s Pulmonary Physicians’ Hall of Fame.

Despite his extensive list of accomplishments, Dr. Petty always remained approachable with patients. His friendship was cherished by all who knew him personally – and many who did not. Dr. Petty is greatly missed by his daughter Caryn, sons Tom and John, eight grandchildren and his long time friend and colleague Louise Nett.

Medical Conference Notes

These were some of the developments that were presented at an American College of Chest Physicians meeting that will be interesting to follow over the coming years.

A meeting of note at the ACCP conference was on smoking cessation.  This was led by pulmonologists Dr. Jill Ohar and Dr. Stephen Rennard as well as a psychiatrist, Dr. John Hughes.  They discussed the pitfalls of this difficult task.  Smoking cessation is a 2 step process:  physiologic withdrawal and then control of behavior afterwards.  Dr. Hughes discussed a few things people can do to help control behavior.  These include the following:  Identify high risk situations and avoid them.  Identify specific cues and triggers that may

Medical Conference Notes

At a recent conference of the American College of Chest Physicians held in Canada some of the topics discussed there were relevant to COPD.  With regard to the venue, one might ask why hold an “American” chest physician meeting outside the United States?  First, the ACCP meeting is an international meeting where people from all over the world come to exchange information about the latest clinical aspects of respiratory illness.  Canada, itself, has a rich history of outstanding contributors to the understanding of

Insomnia, that is, the inability to fall asleep and stay asleep at appropriate times is a very common problem. I venture to say that nearly every person has had some degree of sleeplessness at one time or another. I am not talking about the restlessness of anticipation, such as just before holidays, big trips, or other special events. I am talking about when there is nothing particularly on your mind, either good or bad, and you just can’t sleep.