IMPROVED EXERCISE PERFORMANCE FOLLOWING LUNG-VOLUME REDUCTION SURGERYFOR EMPHYSEMA

Lung volume reduction surgery (LVRS) for emphysema has been suggested to improve patient lung function and activity. The short-term impact o f LVRS on exercise performance was evaluated using maximal and submaxi mal steady-state exercise testing in 27 patients with severe hypoxemic chronic obstructive pulmonary disease (COPD), along with measurements of patient function, dyspnea, and quality of life. LVRS significantly improved exercise performance, due to ventilatory improvements associ ated with increased ventilatory reserve, enhanced tidal volume recruit ment, and improved alveolar ventilation. Preoperative measurements of ventilatory reserve and dead space ventilation during exercise testing were closely associated with improved exercise performance. Improveme nts in patient dyspnea, walk distances, and quality of life also occur red following LVRS and were associated with improvements in exercise p erformance. Surgical mortality from LVRS was low (4%), but shortterm a ll-cause mortality was increased (19%). Short-term mortality was assoc iated with reduced expiratory muscle strength and markedly elevated de ad space ventilation. We conclude that LVRS produces significant impro vements in exercise performance, dyspnea, and quality of life in selec ted patients with COPD. Physiologic prediction of patients most likely to survive for an extended period and have significant benefit follow ing LVRS may also be possible.