Emphysema: Surgery Can Help

The illuminated Giza Pyramids in Cairo, Egypt, are seen from across the Nile Monday, Feb. 5, 2007. Egypt is scoffing at a global contest to name the new Seven Wonders of the World, saying it's a disgrace that the Pyramids of Giza, the only surviving structure from the original list of architectural marvels, must compete for a spot.
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To a civillian's ear, lung reduction surgery sounds like an operation that couldn't possibly be good for you.

It's a procedure in which doctors reduce the size of your lungs, by removing lung tissue damaged by emphysema: tissue which is supposed to expand and collapse as you inhale and exhale, but no longer does, a bit like an old rubber band that's lost its snap.

The patient is left with less lungs to do the job, but what's left, is healthier.

CBS News Medical Correspondent Dr. Emily Senay reports a study of 200 patients concludes that the surgery is safe and effective both in improving quality of life and in prolonging life.

There are approximately two million Americans with emphysema and, according to the American College of Chest Physicians, almost all of them are smokers, except for about three percent with a genetic predisposition to the disease.

The study at Barnes Jewish Hospital/Washington University School of Medicine in St. Louis found that:

  • lung function was generally improved by 50 percent
  • patients experienced a significant increase in the distance they could walk in a period of six minutes
  • 82 percent reported a marked improvement in the ability to breathe
  • 4 percent experienced a worsening in their ability to breathe
  • 84 percent reported good to excellent satisfaction with the surgery, with annual patient survival rates of 93 percent in the first year, 87 percent in the second year, 82 percent in the third year, 74 percent in the fourth year and 71 percent in the fifth year.
Patients who undergo the surgery will still suffer over time some further deterioration of the ability to breathe, but Senay says "since there's nothing better available at the moment, for those who aren't responding (to other treatments), it's worth a try."

Other treatments include inhaled medicines to open up air passageways, oxygen, exercise, and dietary changes.

Insurance company coverage of lung reduction surgery continues to be an issue for many patients.

"Most private insurance pays for it, but Medicare does not cover the operation," reports Senay. "They are waiting for the results of a bigger study before they agree to cover it. But the latest data shows that people who don't get the surgery when they need it live shorter lives, so the issue of Medicare coverage is controversial."

The larger study, now in progress, is a federally-funded clinical trial of 4,500 patients at 16 different facilities around the country. The clinical trial, which is expected to take as long as seven years to complete, is being sponsored by the National Heart, Lung, and Blood Institute, the Health Care Financing Administration, and the Agency for Healthcare Research and Quality.

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