UCLA Campus    |   UCLA Health    |   School of Medicine Translate:
UCLA Health It Begins With U

Clinical Updates

Print
Email

Clinical Updates

 
Pulmonary Medicine

Lung volume reduction surgery and investigational valve implants offered to carefully selected COPD patients

10/01/2007

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, afflicts 24 million Americans (about 8 percent of the population). This common disease impairs pulmonary function and exercise capacity and has a negative impact on patients’ health-related quality of life. While standard conservative care – including pulmonary rehabilitation – can improve symptoms, some patients can benefit from more interventional treatment to reduce over-inflation of the lungs and improve their mechanical function.

Emphysema leads to lung over-inflation when air becomes trapped in areas of the lungs that have lost the elasticity they need in order to expel air, creating dead spaces that do not contribute to respiration. Research has shown that COPD patients with upper-lobe-predominant disease who have low exercise capacity can benefit from lung volume reduction surgery (LVRS), in which diseased areas of the lungs are resected via thoracoscopy.


Lung volume reduction surgery

UCLA was among the 19 centers that took part in the original research study (the National Emphysema Treatment Trial) and continues to be a leading center for lung volume reduction surgery. Patients are evaluated using CT (computed tomography) scans, pulmonary function tests, cardiac assessment, nuclear medicine perfusion tests and other diagnostic tools. At a weekly review meeting, pulmonologists, surgeons, nuclear medicine physicians, cardiologists and radiologists carefully consider each case and make recommendations.

Recommended only for highly qualified patients, the bilateral thoracoscopic LVRS usually requires a five-day hospital stay. Patients begin pulmonary rehabilitation soon after the surgery in order to achieve optimal results.


Investigational valve implants

In recent years, one-way valve implants have been developed to provide a less invasive, reversible alternative to LVRS. UCLA is currently enrolling qualified patients in the Valve Intervention Treatment Trial, a clinical study of a new one-way valve to treat the same patient population that has been shown to benefit from LVRS. The investigational treatment involves inserting a bronchoscope through the patient’s mouth and into the upper lobes of the lungs. A one-way valve is delivered by catheter to each of six subdivisions of the upper lobes. Once deployed, the valves expand to occlude the passage, preventing air from entering the damaged areas while permitting trapped air and secretions to escape. The valves can, if desired, be removed via catheter.

Patients who qualify as candidates for LVRS will be offered the option of participating in the valve treatment trial. In the randomized, blinded study, patients will be assigned at the time of their procedure to either the study group receiving valve implants, or a control group that will receive only a bronchoscopic exam for signs of lung cancer.

Patients will be evaluated at three months and again when the study concludes in six months. The primary outcome measure will be health-related quality of life. Lung volume as determined by CT scan will be a secondary outcome measure. Patients will also be tested for six-minute walking distance, breathlessness score and pulmonary function. At the conclusion of their six-month follow-up, patients from the control group will be offered the valve implant procedure.

Contact information

For more information, or to refer a patient, please use the following numbers:

(310) 206-7858 UCLA Outpatient COPD Clinic
(310) 206-0396 Valve Intervention Treatment Trial study coordinator


Program physicians

The following are members of the lung volume reduction surgery evaluation team and the valve treatment study at UCLA.

Robert Cameron, M.D.
Associate Professor of Clinical Surgery

Christopher B. Cooper, M.D.
Professor of Medicine and Physiology
Medical Director, UCLA COPD Program
Principal Investigator, Valve Intervention Treatment Trial

Magnus Dahlbom, M.D.
Professor of Nuclear Medicine

Jonathan Goldin, M.D., Ph.D.
Professor of Radiological Sciences

Eric C. Kleerup, M.D.
Associate Clinical Professor of Medicine, Critical Care and Pulmonary Disease

Raja Mahidhara, M.D.
Assistant Professor of Surgery

Irawan Susanto, M.D.
Clinical Professor of Pulmonary Medicine

Helga Van Herle, M.D.
Assistant Clinical Professor of Cardiology





Add a comment


Please note that we are unable to respond to medical questions through the comments feature below. For information about health care, or if you need help in choosing a UCLA physician, please contact UCLA Physician Referral Service (PRS) at 1-800-UCLA-MD1 (1-800-825-2631) and ask to speak with a referral nurse. Thank you!


comments powered by Disqus