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Thursday, April 17, 2014
Smoking and Tobacco
Prognosis of End Stage Emphysema
What is end stage emphysema? Can your breathing suddenly drop with emphysema? What is the prognosis of someone in the end stage of emphysema? How long do they live? Can they benefit from LVRS?
Please click on the link titled "Stages of Emphysema" below for a discussion of end- stage emphysema.
Prognosis is dependent on many factors and a prediction of how long a person will live with end-stage emphysema is difficult to make. The person with this condition should discuss prognosis with his or her physician who has more information on their personal health condition.
LVRS (lung volume reduction surgery) is a treatment option available to some patients with end-stage emphysema. During this procedure 20 to 30% of diseased lung tissue is surgically removed. This includes tissue at the apices (tops) of the lungs and tissue that is bullous (large blebs of non- functioning lung tissue). This tissue is identified before the surgery by the use of specialized CT scanning of the lungs. It is thought that by removing the over-expanded, diseased tissue that there is more room for the remaining lung tissue to expand and that the ribs and diaphragm resume more normal positions in the chest, allowing for better lung mechanics. This is supposed to improve breathing, decrease the sensation of shortness of breath, increase exercise tolerance and improve the quality of life. It can take up to six months for the full benefits to be achieved.
Good candidates for this surgery include people with pulmonary function tests that show: 1) a forced expiratory volume in one second (FEV1) that is 10-40% of predicted; 2) a residual volume greater than 180% of predicted; and 3) a total lung capacity over 110% of predicted.
Poor candidates for this surgery include: 1) age over 75; 2) obesity; 3) currently smoking; 4) bronchiectasis; 5) cancer; 6) heart disease; 7) prior lung resection surgery; 8) pleural abnormalities; 9) six-minute walk less than 250 feet after rehab; 10) any disease that limits survival to less than five years; 11) mental incompetence or active psychiatric illness; 12)interstitial lung disease; 13) elevated blood carbon dioxide level to 50 mm Hg or greater; 14) diffusion capacity less than 25% of predicted; 15) ventilator dependence; 16) supplemental oxygen use over six liters per minute to maintain blood oxygen levels of greater than 87%; 17) more than one cup of sputum production per day; and 18) pulmonary hypertension.
Medicare currently does not pay for LVRS because "there is little medical evidence available to base a determination that this procedure is safe and effective."
As of April 24, 1996, the National Institutes of Health (NIH) and the Health Care Financing Administration (HCFA) are collaborating on a multi-center, randomized clinical study on the effectiveness of LVRS. This will be a seven-year study involving 3,000 patients at 18 sites across the country. HCFA has agreed to pay the medical and surgical costs of Medicare recipients enrolled in this study.
Margaret C Sweeney, MD
Formerly, Associate Professor of Clinical Family Medicine
College of Medicine
University of Cincinnati