Time course of symptomatic improvement following Lung Volume Reduction Surgery (LVRS) and comparison to improvement following Pulmonary Rehabilitation (PR)

Purpose: To determine the time course of improvement in patients undergoing LVRS and to compare the extent of the improvements to the results of PR prior to surgery. Methods: Prior to LVRS, patients underwent a minimum of 6 weeks of PR, reaching a plateau in functional improvement. Subsequent to LVRS the patients were followed up at 1, 3, and 6 months. Dyspnea was quantitated by the Medical Research Council (MRC) scale and the Mahler Dyspnea Index (MDI). Functional status was measured by the Human Activity Profile, which is scored as the maximal activities score (MAS) and an adjusted score (AAS). Quality of Life was measured by the SF-36 Health Status Questionnaire (SF-36). The SF-36 provides scores in 9 domains as well as an aggregate score. Results: Functional status (AAS) trended towards improvement during PR (p=0.1), fell at 1 month (p=.03), and improved beyond the PR measurement at 3 and 6 months (p=.008, .0003, respectively). A similar pattern was seen for the MRC, MDI, and SF-36 with continuing improvement through 6 months. The domains of the SF-36 with most significant improvements following surgery were general health transition, vitality, and physical function. There was general worsening in the pain index. Conclusion: Patients undergoing LVRS symptomatically benefit beyond the improvements seen with pulmonary rehabilitation alone. One month following surgery, patient functioning, quality of life and functional status trend towards worsening, followed by significant improvements at 3 and 6 months. Clinical Implications: Evaluations of improvement following LVRS should be controlled by comparison to improvement with pulmonary rehabilitation alone and must take into account the time course of improvement following surgery.