Easy volume reduction operation involves removing the diseased part of lung emphysema, which probably allows nondiseased parts function more efficiently buy lasix generic online. The National Emphysema Treatment Trial, 1218 patients with emphysema were randomized for lung volume reduction surgery or treatment. In 2001, researchers reported unacceptably high mortality in the subgroup of 70 surgical treatment of patients with very low FEV
20% good) and several other high-risk characteristics (). Now, the conclusions for the entire cohort have been published. Mortality was significantly higher in the surgical group than medical group within 90 days (7. 9% to 1. 3%), but 26% in both groups after the average period of observation was 29 months. In the post analysis of specific subgroups of patients with predominantly upper lobe emphysema and low baseline physical activity had significantly lower mortality in the operation compared with drug therapy (19% vs. 34%). In contrast, patients with predominantly upper lobe without disease and high physical activity was significantly higher mortality in the operation compared with drug therapy (25% vs. 13%). For other combinations of spreading disease and exercise tolerance, mortality did not differ from surgical and medical treatment. At 24 months, significantly higher proportion of surgical patients than medical patients experienced improved exercise tolerance (15% vs. 3%) and health-related quality of life (33% vs. 9%). Comment: It is easy, the volume reduction surgery benefit? This process gave no "one size fits all" answer. As previously reported, the procedure is contraindicated in high-risk subgroup, but some other subgroups experienced lower mortality and improve symptoms for about 2 years of observation. Because these conclusions are partly based on analysis after the fact, journalists require additional studies. Finally, according to the companion article, additional cost-effectiveness of this procedure an average of 3 years U.S. $ 190.000 per quality adjusted life year experience.
Posted in Journal Watch therapeutic June 3, 2003
Member emphysema Treatment Trial Research Group. Randomized studies comparing lung volume reduction operations with drug therapy of severe emphysema. N Engl J Med 2003 May 22, 348:2059-73. National Emphysema Treatment Trial Research Group. Economic efficiency of light volume reduction surgery for patients with severe emphysema. N Engl J Med 2003 May 22, 348:2092-102. Drazhen M. Epstein and AM. Management of surgery for emphysema. N Engl J Med 2003 May 22, 348:2134-6. .
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