Chest
Volume 115, Issue 2, February 1999, Pages 383-389
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Clinical Investigations
VOLUME REDUCTION SURGERY
Health-Related Quality of Life Improves Following Pulmonary Rehabilitation and Lung Volume Reduction Surgery

https://doi.org/10.1378/chest.115.2.383Get rights and content

Study objectives

To evaluate changes in health-related quality of life (HRQL) as assessed by the Medical Outcomes Study Short Form 36-item questionnaire (SF-36) after pulmonary rehabilitation and lung volume reduction surgery (LVRS).

Patients

Nineteen patients with severe emphysema who underwent pulmonary rehabilitation in preparation for LVRS.

Interventions

Pulmonary rehabilitation followed by bilateral sequential LVRS.

Measurements and results

HRQL assessed by the SF-36 was measured at baseline, after pulmonary rehabilitation, and 6 months after LVRS. One-way analysis of variance with repeated measures demonstrated no significant change from baseline in any of the eight domains after pulmonary rehabilitation. Scores for only one domain, vitality, improved significantly after LVRS compared with scores after pulmonary rehabilitation. However, significant improvements over baseline scores were demonstrated after combined preoperative pulmonary rehabilitation and LVRS in the domains of physical functioning, role limitations due to physical problems, social functioning, and vitality. Pulmonary rehabilitation contributed most to the overall improvements in role limitations due to physical problems, whereas LVRS contributed mainly to the overall improvements in physical functioning, social functioning, and vitality.

Conclusions

Patients with severe emphysema experience significant improvements in both physical and social health status as assessed by the SF-36 after combined pulmonary rehabilitation and LVRS. Each intervention makes unique and complementary contributions to the overall improvements in HRQL.

Section snippets

Study Population

A cohort of 19 patients with severe emphysema (FEV1 < 40% predicted) was studied between August 1994 and July 1997. All patients had radiographic evidence of emphysema and hyperinflation without significant bullous disease. Neither a heterogeneous pattern of parenchymal destruction nor disease predominantly confined to the upper lobes, based on quantitative ventilation-perfusion scanning or chest CT scan, was included in the selection criteria. Patients who had evidence of bronchodilator

Results

The cohort of 19 patients (mean age, 61.9 ± 8.5 years) included 13 men and 6 women who underwent a total of 38 procedures. All patients had severe emphysema, with a mean preoperative FEV1 of 0.74 ± 0.26 L (24 ± 9% predicted) and FVC of 2.64 ± 0.91 L (67 ± 23% predicted). All patients reported compliance with their maintenance aerobic exercise regimens. Table 1 displays the patients’ preoperative and perioperative characteristics. Prior to LVRS, 13 patients required supplemental O2 based on

Discussion

HRQL improved after the combination of pulmonary rehabilitation and LVRS in patients with severe emphysema, although each intervention alone was not associated with significant improvements in HRQL. Furthermore, each therapeutic intervention contributed uniquely to the overall improvements in various domains of the SF-36. Pulmonary rehabilitation and LVRS complemented each other to improve both physical and social health status.

Although LVRS significantly improved FEV1 and had the greatest

Conclusion

HRQL provides outcome information that is independent from and complementary to pulmonary function measures. HRQL should be measured directly in patients with emphysema at baseline and after therapeutic interventions. HRQL improves after combined preoperative pulmonary rehabilitation and LVRS in patients with severe emphysema. Each intervention makes a unique and complementary contribution to the overall improvements in HRQL. Increases in lung function explain only part of the improvements in

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    Supported in part by National Institutes of Health/National Heart, Lung, and Blood Institute grant HL07633.

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