Lung Volume Reduction Program

Lung Volume Reduction Program

Emphysema patients suffer from debilitating shortness of breath due to hyperinflation. The aim of lung volume reduction (LVR) is to reduce hyperinflation in patients with COPD, thereby improving dyspnea and quality of life. The National Emphysema Treatment Trial (NETT), which Cleveland Clinic participated in, has shown that, in appropriately selected patients, the procedure is associated with an improvement in symptoms and survival.

Cleveland Clinic’s LVR surgery program predates the NETT and consists of teams from the Respiratory Institute and division of Thoracic Surgery from the Heart and Vascular Institute. Cleveland Clinic’s program offers video-assisted thoracoscopic surgery, a less morbid procedure compared with median sternotomy in achieving LVR.

Potential candidates are screened and evaluated in the Center for Comprehensive Care in COPD at the Respiratory Institute. Thoracic surgeons, pulmonologists, radiologists, advanced practitioners, and respiratory therapists meet regularly to discuss the cases of patients referred for LVR surgery, and consensus recommendations are then shared with referring physicians. Because of the extensive preoperative and longitudinal management these complex patients require, Cleveland Clinic has built a program that facilitates preoperative workup. Whenever possible, Cleveland Clinic works with local Pulmonary Rehabilitation programs to prepare patients for the procedure. When patients are brought to Cleveland, testing and clinical assessment are carried out through coordinated appointments that allow rapid patient evaluation.

In 2018, Cleveland Clinic screened 65 patients and performed 3 LVR surgeries. After having been involved in several clinical trials of bronchoscopic LVR protocols, Cleveland Clinic has begun evaluating patients for bronchoscopic LVR following FDA approval of endobronchial valves for clinical use in 2018.