FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CONSULT BOTH BANKER AND DOCTOR BEFORE THIS SURGERY

Question: My husband has had trouble with emphysema for a number of years. He seems to be getting worse despite seeing the doctor regularly. We've read about lung reduction surgery for his condition. Can removing a part of a lung actually help someone breathe better? This sounds very strange!

Answer: Emphysema is a chronic disease that slowly destroys the lungs. This happens when tiny air sacks called alveoli become swollen and ineffective. It is within these alveoli that your blood picks up oxygen and gives off carbon dioxide.

When alveoli become enlarged they increase the physical size the volume of the lungs. As a result, the chest and diaphragm are stretched and distended as if taking a deep breath, even when the person is exhaling. This "stretch-while-at-rest" shape of the chest consequently limits additional chest expansion and makes it impossible to take a deep breath. The end result is that the individual with emphysema has markedly limited ability to do physical work because of persistent breathlessness.

Over the last 50 years there have been a variety of "wonder surgeries" designed to help those suffering from emphysema. Several styles of surgery have been used to allow greater movement of the chest. The thought was that this would make more space for the enlarged lungs to expand and, thereby, make breathing easier. Because results ranged from dismal to absolutely devastating, these surgeries are no longer used.

Another approach to emphysema surgery was pioneered by Brantigan in 1957. This entailed surgical removal of some of the emphysema damaged area of the lung itself usually 20 to 30 percent of the total lung volume. This would leave more space for the more nearly normal lung tissue to work and thus improve breathing performance. Brantigan's surgeries weren't very successful and fell from general use. This wasn't because he had the wrong ideas; he just didn't have the proper equipment.

In 1994 Joel Cooper of Washington University in St. Louis, Mo., published a research paper showing significant benefit from lung reduction surgery Brantigan's 37-year-old idea modified by modern surgical equipment and techniques. It is Cooper's success that has renewed worldwide interest in lung reduction surgery.

The hope of benefit from lung reduction surgery has impacted on many individuals, since there are currently about 14-million Americans with this disease and 85,000 deaths each year directly attributed to emphysema. Persons most likely to be candidates for the surgery are those without other serious diseases such as heart problems or diabetes, who no longer use tobacco (the cause of almost all emphysema in persons younger than 75), and who have $50,000 or more to spend on the surgery. You see, lung reduction surgery isn't currently covered under Medicare or by most other insurance policies.

Talk with your husband's doctor and an experienced thoracic cardiovascular surgeon. They can help you determine if lung reduction surgery would benefit him. Unfortunately, you might also need to talk with your banker.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.