Surgical Interventions for COPD

Max Huang, MD, FRCPC; Lianne G. Singer, MD, FRCPC

Disclosures

Geriatrics and Aging. 2005;8(3):40-46. 

In This Article

Abstract and Introduction

Abstract

Chronic obstructive pulmonary disease (COPD) often has a profound effect upon the quality of life and mortality of the older adult. Despite numerous medical treatments, surgery may be considered for the symptomatic patient with medically-optimized, end-stage COPD. Bullectomy, lung volume reduction surgery (LVRS), and lung transplantation have all proven to be important surgical therapies. This article reviews the current state of these interventions, and the criteria when deciding on the best surgical option for a given patient.

Introduction

Approximately 710,000 Canadians suffer from chronic obstructive pulmonary disease (COPD),[1] and hundreds of thousands more may have this disease but have never been diagnosed. COPD is largely a disease of older adults; in individuals older than 75 years the prevalence is approximately 6.9%,[1] compared with 4.6% in individuals aged 55 to 74.

COPD is a slow and irreversible process that progresses over several years, often punctuated by exacerbations and eventually leading to death. According to the 1998/9 National Population Health Study (NPHS), 51% of individuals with COPD reported that shortness of breath caused some restriction in their home, work, and social activities. In Canada, COPD is the seventh most common cause of hospitalization for men and the eighth for women, with a rehospitalization risk of approximately 40%.[2] It is also the fourth leading cause of death in Canadian men and the fifth leading cause of death in Canadian women. However, these figures may be underestimates and the listed cause of death of COPD patients may instead reflect the often-associated pneumonia or congestive heart failure. Economic impact studies suggest that the cost of COPD on Canada's health care system now exceeds $3.2 billion each year,[3] a figure that is expected to rise exponentially over the next several years.

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