Recent reports of lvrs showed improved fev1

LVRS is intended primarily for those patients who have chronic obstructive pulmonary disease (COPD), mainly emphysema. Emphysema is characterized by abnormal anatomically, permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of airspace walls and without obvious fibrosis. The loss of lung architecture resulting in a compressible peripheral airways, closing at above normal lung volume (early closure of the airways). Increased compliance and capture the air of an early closure leads to hyperinflation of the lungs, chest wall tensile, flat, rejected by the diaphragm and ventilation-perfusion mismatch. In 1950 and 1960, Dr. Otto Brantigan suggested that surgical removal of several wedges easily lead to a reduction in lung volume, thus restoring the external elastic attraction in small airways and reduce airway obstruction. Dr. Brantigan reported that surgical excision of lung tissue leads to significant clinical improvement in some cases, but mortality was high. With little objective data and high mortality, the procedure is not widely known. Experience diaphragmatic function and chest can be recovered in emphysema transplantation renewed interest in the work of Dr. Brantigan in. Improvement of surgical techniques have opened the possibility of surgical excision of lung tissue. Recent reports of LVRS showed improved FEV1, FZHYEL, TLC, RV and dyspnea and quality of life assessments. These reports caused great excitement among patients and their physicians. Many centers around the country began to speak LVRS resulting in hundreds of patients who underwent the procedure, despite the preliminary results, the absence of strict selection criteria of patients and lack of information about long-term results. Key questions remain as to the patient should have surgery, which protocol should be respected, that physiological tests should be obtained, and that in the long term efficiency of vehicles on morbidity, mortality and quality of life. Mechanisms of benefit and the consequences of heart is unknown. The concept originated in the court NHLBI workshop on evaluation and research in surgical lung volume reduction. This initiative was reviewed and approved in May 1996 National Heart, Lung, and Blood Advisory Council. A request for proposals issued in June 1996. In the study, 1218 patients' rights were randomized to receive drug therapy or (610) or medical therapy with LVRS (608). LVRS was performed medium sternotomy or video-assisted thorascopic surgery (VAT). Centers randomized patients or) medical therapy compared with drug therapy with LVRS by median sternotomy, b) medical therapy compared with drug therapy with LVRS by VATS, or c) medical therapy compared with drug therapy with LVRS by median sternotomy versus drug therapy LVRS with bilateral VATS. Drug therapy included pulmonary rehabilitation and education. Direct comparison of two surgical methods were possible only in centers that performed both methods. All weapons included intensive pulmonary rehabilitation. Primary endpoints were survival and functional improvement at maximum load rating. Secondary end points included morbidity, improving lung function, quality of life lasix drug dose and efficiency of daily activities. The following examinations, including history, physical examination, pulmonary function tests, exercise testing and quality of life is estimated to have occurred after the preoperative rehabilitation and six and twelve months after surgery and every twelve months. Recruitment, which ended July 31, 2002 and later ended in December 2002. .