Lung Volume Reduction Surgery and Pulmonary Rehabilitation Improve Exercise Capacity and Reduce Dyspnea During Functional Activities in People with Emphysema

IntroductionAlthough lung volume reduction surgery and bronchoscopic lung volume reduction with endobronchial valves have both been shown to improve lung function, exercise capacity and quality of life in appropriately selected patients with emphysema, there are no direct comparison data between the two procedures to inform clinical decision-making.Methods and analysisWe describe the protocol of the CELEB study, a randomised controlled trial which will compare outcomes at 1 year between the two procedures, using a composite disease severity measure, the iBODE score, which includes body mass index, airflow obstruction, dyspnoeaand exercise capacity (incremental shuttle walk test).Ethics and disseminationEthical approval to conduct the study has been obtained from the Fulham Research Ethics Committee, London (16/LO/0286). The outcome of this trial will provide information to guide treatment choices in this population and will be presented at national and international meetings and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter.Trial registration numberISRCTN19684749; Pre-results.

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Lung volume reduction surgery for severe emphysema increases exercise capacity but not does not affect mortality

Thorax ◽

10.1136/thorax.58.8.720 ◽

2003 ◽

Vol 58 (8) ◽

pp. 720-720 ◽

Cited By ~ 2

Author(s):

P Lawson

Keyword(s):

Exercise Capacity ◽

Lung Volume ◽

Volume Reduction ◽

Lung Volume Reduction Surgery ◽

Lung Volume Reduction ◽

Severe Emphysema

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Lung Volume Reduction in Pulmonary Emphysema

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0040-1702192 ◽

2020 ◽

Vol 41 (06) ◽

pp. 874-885 ◽

Cited By ~ 1

Author(s):

Justin L. Garner ◽

Pallav L. Shah

Keyword(s):

Exercise Capacity ◽

Lung Volume ◽

Safety Data ◽

Clinical Excellence ◽

The United States ◽

Volume Reduction ◽

Lung Volume Reduction ◽

Novel Technologies ◽

Mechanical Constraints ◽

Improve Exercise Capacity

AbstractSevere emphysema with hyperinflation presents a therapeutic challenge. Inhaled medication has limited efficacy in individuals with mechanical constraints to the respiratory pump and impaired gas exchange. Lung volume reduction surgery (LVRS) reestablishes some semblance of normal physiology, resecting grossly expanded severely diseased tissue to restore the function of compromised relatively healthy lung, and has been shown to significantly improve exercise capacity, quality of life, and survival, especially in individuals with upper-lobe predominant emphysema and low-baseline exercise capacity, albeit with higher early morbidity and mortality. Bronchoscopic lung volume reduction achieved by deflating nonfunctioning parts of the lung is promoted as a less invasive and safer approach. Endobronchial valve implantation has demonstrated comparable outcomes to LVRS in selected individuals and has recently received approvals by the National Institute of Clinical Excellence in the United Kingdom and the Food and Drug Administration in the United States of America. Endobronchial coils are proving a viable treatment option in severe hyperinflation in the presence of collateral ventilation in selected cases of homogeneous disease. Modalities including vapor and sealant are delivered using a segmental strategy preserving healthier tissue within the same target lobe-efficacy and safety-data are, however, limited. This article will review the data supporting these novel technologies.

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