Lung volume reduction surgery: A great option for patients with severe emphysema

Every time Susan Fischer sees someone lugging around an oxygen container, she wants to pull them aside and tell them, "It can get better."

Fischer, 65, has severe emphysema, also known as chronic obstructive pulmonary disease (COPD), which is an ongoing and progressive disease that damages the lungs and makes breathing difficult. With her son's wedding coming up and her daughter expecting a baby girl, Fischer was determined to not let her condition slow her down so she underwent a lung volume reduction (LVRS) surgery at Northwestern Memorial Hospital in December 2012. A few months after the procedure, Fisher welcomed her new granddaughter and danced at her son's wedding.

"For the first time in a while I was able to take a deep breath," said Fischer, an Arlington Heights resident. "You have no idea how good that feels."

LVRS is a procedure that removes approximately 20 to 35 percent of the lungs that are damaged by emphysema, allowing the remaining, relatively good lung to expand and work better. Researchers believe that by surgically removing functionally useless tissue, air will be able to move in and out of the remaining lung more quickly. The operation is done through either a breast bone incision or smaller chest incisions using video-assisted thoracic surgical techniques.

"Lung volume reduction surgery is a great option for select patients with severe emphysema," said Malcolm DeCamp, MD, chief of the division of thoracic surgery at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. "This is a surgical option to help people with severe emphysema gain a better quality of life and prolong life."

COPD is the third leading cause of death in the United States, only behind heart disease and cancer; 12 million Americans are diagnosed with COPD. Currently, the only studied interventions that prolong life for patients with severe COPD are supplemental oxygen in people with low oxygen levels and LVRS in appropriately selected individuals. For patients like Fisher even simple tasks such as walking short distances can leave them breathless – an activity as physically demanding as dancing is impossible for many.   

"Before this procedure, every single day was difficult," Fischer said. "If it was too windy I couldn't go outside. I had to take my oxygen everywhere; I even had to wear it in the shower. But now, I don't get as tired. I'm not as breathless.  I had a whole weekend where I didn't have to use oxygen."

Despite making a major difference for patients suffering from COPD, lung volume reduction surgery isn't done very often in the United States, said Ravi Kalhan, MD, director of the asthma and COPD program at Northwestern Memorial.

"Although there is sometimes a perception that we have limited treatment options for COPD, the ones we do have, including inhaled medications, programs of rehabilitative exercise, and in appropriately selected patients LVRS can make a huge difference in a person's quality of life," said Kalhan, who is also an associate professor of medicine at the Feinberg School. "Susan was the ideal candidate for lung volume reduction surgery. She has severe COPD, but she is extremely motivated to do whatever it takes to improve her quality of life."

"The most important message to people living with COPD is that this is a treatable condition," Kalhan said. "With continued research, treatment options for these patients will continue to improve."