Mechanisms of Relief of Exertional Breathlessness Following Unilateral Bullectomy and Lung Volume Reduction Surgery in Emphysema

To explore mechanisms of relief of exertional breathlessness following surgery to reduce thoracic gas volume in patients with emphysema. We studied 8 patients with emphysema (FEV1=39±3% predicted; residual volume [RV]=234 ± 12% predicted; mean±SEM) who were severely breathless despite optimal pharmacotherapy and who underwent unilateral bullectomy for giant bullae (greater than one third hemithorax); 4 of these also had ipsilateral lung reduction (pneumectomy). Pulmonary function and cycle exercise performance (n=6) were evaluated before and 13 ± 3 weeks after surgery. Chronic breathlessness was measured with the Baseline Dyspnea Index and the Medical Research Council dyspnea scale. Exertional breathlessness was measured using Borg ratings at a standardized work rate (BorgSTD). FEV1, FVC, and maximal inspiratory pressures increased postsurgery by 29 ± 7% (p