The impact of reduction pneumoplasty for emphysema on quality of life: a randomized prospective study.

Purpose. To evaluate the impact of Reduction Pneumoplasty (RP) on Quality of Life (QOL) by comparing these patients with a homogeneous group treated only with Respiratory Rehabilitation (RR). Methods. Sixty patients who met inclusion criteria for RP were prospectively randomized by computer between January 1996 and January 1999 to receive either RP (n=30) or comprehensive RR (n=30) program for a minimum of 6 week. QOL was evaluated by both the Nottingham Health Profile (NHP) and the Short Form 36-item (SF-36) questionnaires. Pulmonary function, respiratory muscle strength, 6-minute walking (6MW) tests were performed at baseline and at 6 months. A 6-month period of observation was chosen to allow crossover of unimproved patients to the most effective treatment after follow-up evaluation. Reliability of the questionnaires was proved by the Cronbach’s alpha test. Statistical significance of the intergroup and intragroup changes at 6 months was determined by appropriate t-test. Multiple stepwise linear regression between variables was performed to evaluate the contribution of functional tests (independent variable) for those QOL scores (dependent variable) which had significantly improved. Results. Two treatment-related deaths occurred after RP and one after RR. At 6 months dyspnea index (p<0.0001), forced expiratory volume in one second (FEV1) (p<0.0001), residual volume (p<0.0001), 6MW (p<0.0002), and PaO2 (p<0.002) improved significantly more after RP than RR. Intergroup (RP vs RR) mean±SD changes were significant for SF-36 general score (15.9±9.3 vs 2.9±4.7, p<0.0001), physical functioning (29.2±27.4 vs 5.8±15.2, p=0.0005), general health (18.7±16.9 vs 2.1±14.3, p<0.0001), social functioning (19.6±18.4 vs 6.5±13.2, p=0.004), and role emotional (40.4±49.1 vs 12.6±46.6, p=0.02) domains. RP intragroup improvements were significant for motility (p=0.003), isolation (p=0.001), and pain (p=0.002) NHP domains and for physical functioning (p<0.0001), general health (p<0.0001), role emotional (p<0.0001), and social functioning (p<0.0001) SF-36 domains. In RR arm only general SF-36 had a significant improvement (p=0.02). FEV1 was significant predictor of general SF-36 (r2=0.35, p=0.001), social functioning (r2=0.32, p=0.001) and transitional health (r2=0.25, p=0.006). No other significant correlation was demonstrable. Conclusions. There is a highly significant QOL improvement, especially of SF-36 scores, after RP. FEV1 was significantly correlated with some postoperative SF-36 domains. Clinical implications. The study indicates that RP is more effective than RR in improving both QOL and lung function tests in selected patients.