Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes : A randomized controlled clinical trial

• Published in: Chest Vol. 128; no. 5; pp. 3489 - 3499
• Main Authors: HILLERDAL, Gunnar, LÖFDAHL, Claes-Göran, STRÖM, Kerstin, SKOOGH, Bengt-Eric, JORFELDT, Lennart, NILSSON, Foike, FORSLUND-STIBY, Dycke, RANSTAM, Jonas, GYLLSTEDT, Erik
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01.11.2005; Elsevier B.V
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Chest; Chronic obstructive pulmonary disease, asthma; Clinical Medicine; Confidence intervals; Emphysema; Emphysema, Pulmonary; Exercise Therapy; Exercise Tolerance; Female; Fitness training programs; Health aspects; Health Status; Health Status Indicators; Health surveys; Humans; Klinisk medicin; lung function; Lungmedicin och allergi; Male; Medical and Health Sciences; Medical Outcomes Study; Medical Outcomes Study Short-Form General Health Survey; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Ostomy; Patients; Pneumology; Pneumonectomy; Pulmonary Emphysema - surgery; Questionnaires; Respiratory Function Tests; Respiratory Medicine and Allergy; Short-Form General Health Survey; St. George Respiratory Questionnaire; Surgery; Thoracic surgery; Sweden; Physical training; Prognosis; Questionnaire; Medical Outcomes Study Short-Form General Health Survey; Cardiovascular disease; Respiratory tract; Randomization; Reduction; Lung function; Surgery; Bronchus disease; Clinical trial; Evolution; Obstructive pulmonary disease; Lung disease; Respiratory disease; Health; Medicine; Lung volume; St. George Respiratory Questionnaire; health status; Survey; Treatment; Surveillance; Emphysema; Comparative study
• ISSN: 0012-3692; 1931-3543; 1931-3543
• DOI: 10.1378/chest.128.5.3489

In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements. After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year. All seven thoracic surgery centers in Sweden. All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS. Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively. Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months. In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.