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 chronic obstructive pulmonary disease (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 Department of Thoracic Surgery from the Heart, Vascular and Thoracic 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 complex cases of patients referred for LVR surgery, and consensus recommendations are then shared with referring physicians. Because of the extensive preoperative assessment and longitudinal management these 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 2023, Cleveland Clinic screened 173 patients for lung volume reduction procedures and performed 6 LVR surgeries on 5 patients.

The COPD center began performing bronchoscopic valve therapy starting in July 2019. In 2023, 32 bronchoscopic valve therapy procedures were performed in 18 patients (11 procedures for repositioning/removal of the valves, 3 procedures discovering collateral ventilation).

COPD = chronic obstructive pulmonary disease, LVR = lung volume reduction, NETT = National Emphysema Treatment Trial

Improvement in Lung Function and Exertional Capacity

Patients who underwent LVR surgery at Cleveland Clinic between 2004 and 2023 showed improvement in lung function, as measured by forced exhaled volume in 1 second, and exertional capacity, as measured by 6-minute walk test distance.