Aging Begins at 30

Combating Emphysema

When lungs are damaged by tobacco the crimping elastic cells surrounding each air sac are broken and lungs become over inflated. This is the major part of emphysema or tobacco-related lung damage. As well as limiting reinflation, bullae or large blisters of non-useful lung that are otherwise still able to function and also flatten the domes of the diaphragm, a major bellows like muscle between the chest and the belly. These large lungs can also mechanically prevent the collecting chambers of the heart (atria) filling properly when the heart is in its diastolic or filling phase. The reduced supply of blood to the heart pump or ventricle leads to poor heart output to all parts of the body and sometimes to hear failure. Good healthy heart muscle is there but cannot function properly because of compression. Removal of over inflated non-functioning damaged lung can give the residual lung "more breathing space" and the heart more "filling space."

Lung reduction surgery, sometimes called lung shaving, removes the most severely affected lung tissue and allows normal or less damaged lung to expand and receive more oxygen laden air with each breath. This established elastic recoil can be achieved by surgery or lobar sculpting away of useless tissue either on one side with a thoracoscope or both sides by opening up the chest (as is done in coronary artery bypass surgery). This operation is not a cure for emphysema. About 20-30% of the lung is removed but the remainder works better so that there is a 40% increase in lung function and about 70% of the patients can stop using supplemental oxygen. Because elastic recoil has returned in 80% this improvement is best seen by a 10% increase in the distance walked in 6 minutes.

This procedure was introduced in 1950 but the bad effects in severely ill patients was too high but when re-introduced in 1993, although still high (16%) was acceptable because these patients are known to be bad operative risks. It is expensive, about $50,000 plus doctors fees but it is cheaper than a lung transplant, the only realistic alternative. Lung transplant operations for emphysema have increased from 2 in 1994 to over 800 now. The transplant requires expensive maintenance; lung shaving requires practically none.

Emphysema is the fifth leading cause of death in the US and affects 1 million Americans at a cost of $12 billion yearly.

As smoking decreases and emphysema with it, this operation provides a possibility of salvaging a number of carefully chosen patients. In time with new techniques it may become less dangerous and more economical. A carefully controlled seven year randomized trial in over 2,500 patients is now in progress. If it shows dramatic improvement no doubt the trial will be cut short.

A friend could no longer do her shopping even with supplemental oxygen and walking to the mailbox was very difficult. The only time she could really breathe in comfort was when she was sitting. Still doing nothing, sometimes she needed a wheelchair to get to the car which she could no longer drive. Now she can. After the operation and pulmonary exercise rehabilitation on a stationary bike and treadmill, I saw her at church without her oxygen, happy and relaxed. She told me her quality of life had increased enormously.

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See related Patient Topics COPD (Chronic Obstructive Pulmonary Disease), Emphysema or Lungs and Breathing.

See related Provider Topics COPD (Chronic Obstructive Pulmonary Disease), Emphysema or Lungs and Breathing.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/1996/emphy.html