Sunday, April 09, 2006

Surgical options for COPD

What the hospitalist and PCP need to know is when to refer. The principal options are lung volume reduction surgery (LVRS) and transplantation. Although LVRS remains somewhat controversial the National Emphysema Treatment Trial has helped define the best candidates. These include patients with heterogeneous involvement with emphysema, particular upper lobe disease, DLCO > 20% and FEV1 > 20%. These are general principles, and final selection is very nuanced. Patients with more advanced disease might better be considered for transplantation. Although age cutoffs for transplantation are not absolute, patients older than 65 are not usually considered. The topic is reviewed here in Clinical Pulmonary Medicine.

1 comment:

Anonymous said...

Thanks for a great blog.
I don't have access to the full article, but I did read the abstract, and I noticed that the authors did mention transbronchical approaches for LVRS. The latest results of the Emphasys endo-bronchial valves that produce segmental atelectasis in focal emphysema are mentioned in the March issue of Chest.
This might offer some palliation for those COPD folks who are too ill to undergo radical LVRS. I thought it appropriate to plug Interventional Pulmonology here, seems like Pulmonogists need to do more than just routine bronchs. :)
Good but rather dated review of this growing field in NEJM a few years back.