Emphysema / Lung Volume Reduction Surgery
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Over two million Americans are affected by emphysema – one form of chronic obstructive pulmonary disease (COPD). It is a slowly progressing disease of the airways that involves a gradual loss of lung function.
There is an irreversible enlargement of the “air sacs” (alveoli) that make up the lungs and destruction of the walls of the air sacs. Emphysema is a major cause of death and disability in the United States.
Current medical treatments include:
- Smoking cessation
- Pulmonary rehabilitation
- Oxygen therapy
- Medications to open the airways
- Flu shots
- Pneumococcal vaccines
- Prompt treatment of respiratory infections
Surgical treatments include lung transplantation and Lung-Volume-Reduction (LVR) Surgery.
Causes
Cigarette smoking is the most important risk factor for emphysema. Pipe and cigarette smokers develop COPD more often than nonsmokers but not as often as cigarette smokers. In addition to smoking, other factors associated with the occurrence of COPD include environmental pollution by chemicals, secondary smoke, and hereditary tendencies.
Symptoms
Emphysema is characterized by a large barrel-shaped chest and shortness of breath. In the advanced stage, every breath is difficult. A cough may or not be present in individuals with emphysema.
Diagnosis
Physicians diagnose emphysema by physical examination, studies of pulmonary function, chest X-ray, blood tests, oxygen studies, and other non-invasive tests.
Treatment / Surgery
The most critical treatment for emphysema is to stop smoking. Additional medical treatments include medications taken by mouth, medications inhaled into the lungs, oxygen therapy, and pulmonary rehabilitation. Prevention of pulmonary infections is also an integral part of patient management.
Lung-Volume-Reduction Surgery (LVRS) is designed to improve respiratory function in a select group of individuals with severe emphysema. In this operation, the most severely diseased portions of the lungs are removed. This permits the remaining portion of the lung and the diaphragm to work better.
The results of a major multi-center clinical trial to examine the role, safety, and effectiveness of LVRS to treat emphysema was published in 2003. The study, called the National Emphysema Treatment Trial (NETT), was sponsored by the National Heart, Lung, and Blood Institute (NHLBI), the Center for Medicare & Medicaid Service (CMS), and the Agency for Healthcare Research and Quality (AHRQ). The study has also established criteria for identifying patients who are likely to benefit from LVRS.
Currently, CMS covers LVRS for some emphysema patients at some hospitals throughout the United States. They include hospitals that participated in NETT and those that perform lung transplantation. The CMS website lists the facilities that perform LVRS. LVRS is not currently performed at any New Jersey hospital.
Robert Wood Johnson University Hospital is pleased with the announcement by CMS that more hospitals may be able to offer LVRS to their patients. CMS is collaborating with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to develop standards for LVRS. CMS anticipates that as many as 200 hospitals may eventually qualify to perform LVRS.
Please stay check back in the near future for more updates
about standards development and the accreditation process.