Chest
Clinical Investigations: Lung Volume Reduction SurgeryMechanisms of Relief of Exertional Breathlessness Following Unilateral Bullectomy and Lung Volume Reduction Surgery in Emphysema
Section snippets
Subjects
Eight consecutive patients (Table 1) with clinically stable, severe emphysema10 and disabling chronic exertional breathlessness participated in the study after providing informed consent. Selection criteria for surgery (bullectomy and pneumectomy) included the following: (1) unilateral large well-demarcated bullae (> one third hemithorax); (2) anatomic emphysema and visible compression of adjacent lung tissue on CT scan of the thorax; (3) severe breathlessness despite optimization of
RESULTS
Serious complications were encountered in the early postoperative period in only 1 patient who developed pneumonia and required prolonged (6 weeks) treatment in the ICU. This patient eventually made a full recovery. Persistent air leaks (3 to 7 days) were encountered in 3 of the patients. Follow-up evaluations of breathlessness, pulmonary function, and exercise performance were conducted 13±3 weeks after surgery. Two subjects were operated on before completing their presurgery exercise test;
DISCUSSION
Surgery effectively ameliorated activity-related breathlessness as measured by self-rated and observerrated questionnaires, and by standardized Borg ratings during cycle ergometry. The magnitude of benefit was substantial and comparable with that achieved by an 8-week exercise reconditioning program in patients with similar baseline pathophysiologic derangements.24 In general, our results are in keeping with the few previous studies that have used validated instruments to measure exertional
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The physiology and pathophysiology of exercise hyperpnea
2022, Handbook of Clinical NeurologyCitation Excerpt :Correlative analysis has consistently shown a strong association between physiologic “demand-capacity ratios” such as: V̇E:maximal ventilatory capacity (Means, 1924; Cournand and Richards, 1941), esophageal pressure:maximal inspiratory pressure (Killian et al., 1984; Bradley et al., 1986), VT/IC (O'Donnell et al., 2001, 2004, 2006b), IND:maximal IND (Luo et al., 2008; Jolley et al., 2009), and IND/VT (O'Donnell et al., 2006a; Guenette et al., 2014) and dyspnea intensity during exercise in COPD. Moreover, improvement in these ratios following therapeutic interventions is invariably linked to improved dyspnea (O'Donnell et al., 1988a,b, 1996; Donohue et al., 2002; O'Donnell et al., 2004; Peters et al., 2006; O'Donnell et al., 2006a,b; Fuhr et al., 2012; Buhl et al., 2015; Elbehairy et al., 2018a). Efforts to selectively manipulate the relevant physiologic variables (above) to expose obligatory contributions to exertional dyspnea in COPD have met with only limited success.
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Supported by the Ontario Ministry of Health. Denis O'Donnell holds a career scientist award from the Ontario Ministry of Health.
revision accepted April 12.