COPD (Chronic Obstructive Pulmonary Disease)

Emphysema Treatment

What is Emphysema?

Emphysema is a disease in which the walls between the air sacs (alveoli) in the lungs are damaged. As a result, lungs lose their elasticity, and it becomes harder to breathe out.

Healthy lungs stretch as a person breathes in and shrink back as a person breathes out. In emphysema, air gets trapped in the lungs, making them too large for the chest cavity, which causes a person to become short of breath. This shortness of breath initially happens with exercise and eventually with minimum activity and at rest.

Management of Emphysema

Non-surgical methods:

Smoking Cessation
Medications to control symptoms of wheezing and shortness of breath
Oxygen (only if indicated) to help a person breathe easier
Exercise programs and breathing techniques -Behavioral modification and diet for people that are over-weight or under-weight

Surgical procedures:

Lung Volume Reduction - This surgery reduces the size of the lungs damaged by emphysema by removing some of the most diseased parts of the lungs. This will allow the remaining lung to function more normally.
Lung Transplantation - With this surgery, one or both lungs are replaced with normal lungs from a donor. There is a waiting list for this surgery because of the scarcity of donor lungs.

How do I know if I am candidate for the surgery?

You have to be smoke free for 4 months or longer. There are tests that are required in order to determine if you are a good candidate for the lung volume reduction surgery or lung transplantation. These evaluations include:

Breathing tests
Exercise tests
Walk test to assess your functional capacity
Stress test and echocardiogram to assess your heart function
Chest CT scan
Quantitative lung perfusion scan
Blood tests

In addition, all patients interested in lung volume reduction surgery (LVRS) must participate in a 6 - 10 week pulmonary rehabilitation program prior to the surgery as well as 6 - 10 sessions after LVRS.

The Lung Volume Reduction Surgery Procedure

You will be given a general anesthetic that will make you sleep during the surgery. The surgeon will remove approximately 30% of each lung by using small incisions through the sides of your chest. This technique is called "Video-Assisted Thoracic Surgery (VATS).

Risks of Lung Volume Reduction Surgery

As with any surgery, there are risks associated with anesthesia and surgical procedures. The major risks associated with lung volume reduction surgery include pain, bleeding, infection, and prolonged air-leak from surgical site. Potential benefits from the surgery include improved exercise tolerance and less shortness of breath. Some people on oxygen may be able to get off of oxygen. In addition, certain patients may have improved life expectancy as well as quality of life with the surgery.

The diagnostic tests and pulmonary rehabilitation may also have risks associated with them, and those risks will be explained at the time of the respective evaluations and rehabilitation.

What to expect after the surgery

Directly after surgery, you will go to the post-op recovery unit. Within a few hours you will be moved to the surgical floor unit. There will be tubes in your chest wall that will allow fluid and any air leaks from your lungs to drain. You will receive medicines to ease your pain and your breathing. Pulmonary rehabilitation staff will be working with you to assist you getting out of the bed and walking as early as post-op day 1. Your progress will be closely monitored. You will have your chest tubes removed when there is no more sign of air leaks. If your recovery has gone well, you should expect to leave the hospital in about 7-10 days. You will be required to return to pulmonary rehabilitation after you are discharged from the hospital and will continue with follow-up visits as necessary.

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Last Reviewed: Jan 27, 2010

Phillip T Diaz, MD
Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University

Mahasti Rittinger, RRT
Clinical Program Manager of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University