An Alternative to Lung Transplant for Emphysema-Related COPD

For the most seriously ill patients with emphysema-related COPD, lung transplant is the best option. Some patients, however, are not quite that ill but still have severe emphysema with profound limitations in physical activity and quality of life.

Chronic obstructive pulmonary disease (COPD), a progressive lung disease marked by worsening breathlessness, is the third most-common cause of death in the United States. It’s also challenging for physicians to treat.

For qualified patients, lung volume reduction surgery (LVRS) is a viable treatment option, says Robert Schilz, DO, PhD, Director of the Pulmonary Vascular Disease Program and Lung Transplantation at UH Cleveland Medical Center.

Emphysema And The Lungs

Smoking-related emphysema destroys large sections of lung tissue, leaving them essentially useless. The idea behind LVRS — removing approximately 20 percent of the most damaged lung tissue in people who struggle to breathe — is almost counterintuitive, Dr. Schilz says. But it works.

“In the right patients, if you get rid of the bad lung tissue to make more room for the rest of the healthier lungs, the patients feel better, they can walk farther and they live longer,” Dr. Schilz says. “LVRS is only relevant for a small percent of people with smoking-related lung damage, but if you correctly pick those people, they have really dramatic outcomes.”

The National Emphysema Treatment Trial (NETT), a multicentered trial completed in 2003, found that on average, patients who underwent LVRS along with medical therapy functioned better after two years compared with patients who received medical therapy only. NETT also demonstrated that patients whose emphysema was mostly confined to the upper lobes and who had low exercise capacity were ideal candidates for LVRS.

Original Investigators

Dr. Schilz and Philip Linden, MD, Chief of the Division of Thoracic and Esophageal Surgery at University Hospitals and University Hospitals Seidman Cancer Center were original investigators in the NETT trial.

“As part of that group, we helped define who LVRS should be used for and how it should be used,” Dr. Schilz says.

Now with 20 years of experience, Dr. Linden continues to perform lung volume reduction surgeries at UH, and Dr. Schilz continues to identify and select people who could benefit from this surgery.

Related links

Only a few centers in Ohio evaluate patients and offer LVRS, as well as lung transplantation, in patients with advanced disability due to smoking-related lung disease. Learn more about these services at University Hospitals.