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Articles in PresS, published online ahead of print September 20, 2002
J Appl Physiol, 10.1152/jap.00898.2001
Submitted on August 29, 2001
Accepted on August 16, 2002
1 Division of Pulmonary and Critical Care Medicine and Thoracic Surgery, Departments of Anthesia and Critical Care, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Boston, MA, USA
* To whom correspondence should be addressed. E-mail: eingenito{at}partners.org.
Background: This paper examines potential physiological mechanisms responsible for improvement following lung volume reduction surgery (LVRS).
Methods: In twenty-five patients (63 ± 9 yr, 11 males), spirometry (FEV1 and FVC), lung volumes (RV and TLC), small airway resistance (Ru), recoil pressures (Pel), and respiratory muscle contractility (RMC) were measured before, and 4-6 months after LVRS. Data were interpreted to assess how changes in each component of lung mechanics affect overall function.
Results: Among responders (R) (
FEV1 
12%, 150 ml), improvement was primarily due to an increase in FVC, not FEV1/FVC ratio. Among non-responders (NR), FEV1, FVC, and RV/TLC did not change following surgery, although Pel increased in both groups. Both groups experienced a reduction in RMC following LVRS.
Conclusions: LVRS improves function in emphysema by 're-sizing' of the lung relative to the chest wall by reducing residual volume. LVRS does not change Ru but decreases RMC, which attenuates the potential benefits of LVRS generated by reducing RV/TLC. Among non-responders, recoil pressure increased out of proportion to reduced volume, such that no increase in vital capacity, or improvement in FEV1 occurred.
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