Thoracic Diseases COPD

Many acute respiratory conditions can become chronic, particularly when aggravated by environmental factors such as cigarette smoke or air pollution. Chronic Obstructive Pulmonary Disease (COPD), also called Chronic Obstructive Lung Disease (COLD), refers to a group of diseases that share a common feature—difficulty in expelling air from the lungs. The three diseases most commonly labeled COPD are:

1. Asthma
2. Chronic bronchitis
3. Emphysema

While hereditary and environmental factors can play a role in causing or aggravating COPD, smoking is responsible for 82% of cases. COPD is the most common form of pulmonary dysfunction today. According to the 2002 National Health Interview Survey, 24 million Americans have COPD.

COPD is a growing cause of disability and mortality. The fourth leading cause of death in United States, COPD is also the second major cause of disability (behind coronary artery disease).

Types of COPD

Asthma

Asthma is marked by episodes of acute wheezing with shortness of breath, variable cough, and reversible airflow obstruction. In patients with asthma, some irritant causes the muscles of the bronchial tubes to spasm and narrow, and there is a noted increase in the production of mucus. When these occur, the asthma patient experiences shortness of breath, coughing, and wheezing. Asthma is almost always a medically-treatable or medically-controllable disease.

The mainstay of asthma therapy is the use of inhaled bronchodilators and inhaled antiinflammatory medications. While causes of asthma have been linked to heredity factors, it is clear that smoking, air pollution, exposure to dust and fumes, and lung infections worsen the condition.

Chronic Bronchitis

Chronic bronchitis is characterized by chronic cough and sputum production, intermittent wheezing with variable degrees of shortness of breath on exertion, recurring and continuing for months. Chronic bronchitis results from inflammation and swelling of the cells lining the bronchus. This inflammation causes the production of excessive mucus. Both the swelling and excess mucus contribute to the narrowing of the bronchi, making air exchange more difficult and increasing the risk of lung infections for the patient.

Airflow obstruction in chronic bronchitis is usually partially reversible. Therapy in chronic bronchitis centers on inhaled bronchodiltators, particularly atropine derivatives, antibiotics, and occasionally steroid medication for flare-ups. Tendency to develop chronic bronchitis is considered hereditary, but the disease is clearly worsened by smoking, air pollution, exposure to dust and fumes, and lung infections.

Emphysema

Emphysema is a progressive destructive lung disease in which the walls between the tiny air sacs in the lungs are damaged. As a result, the lungs lose their elasticity and breathing out becomes more and more difficult. Air remains trapped in the overinflated lungs.

Emphysema patients report increasing shortness of breath, especially with activity, as well as variable degrees of coughing and wheezing, and irreversible airflow obstruction. Heredity is thought to play a part in the tendency to develop emphysema, but the disease is clearly worsened by smoking, air pollution, exposure to dust and fumes and lung infections.

Surgical Treatments Chronic Obstructive Pulmonary Disease (COPD)

Lung Volume Reduction Surgery (LVRS), involving removal of sections of damaged lung tissue, has shown promising results for patients with end-stage emphysema. By removing the most diseased tissue (up to 30% of the lung volume), the goal is to improve the residual lung function and respiratory mechanics. LVRS can be performed through either median sternotomy (open chest) or video-assisted minimally invasive technique. NewYork-Presbyterian/Columbia is the only medical center in the tri-state area designated by the National Institutes of Health (NIH) as a center of excellence in LVRS for the treatment of emphysema.

Most private insurance plans cover the procedure, while Medicare covers lung volume reduction surgery with condition.

Not all patients with advanced emphysema are candidates for LVRS. For patients who do not qualify for LVRS, we provide other options for treatment, including redirection of airflow by means of bronchoscopically implanted stents and valves. These procedures enable trapped air to escape and improve overall lung function. We are a a major research and treatment center for these airway procedures and are currently offering several through clinical trials.

If you are interested in being evaluated for lung volume reduction surgery, please call the Center for Lung Failure at 212.305.1158 to obtain a patient questionnaire. You will need to discuss your interest in LVRS with your primary physician, who will be asked to provide your medical information to us including history, pulmonary function, and x-ray studies.

The staff at the Center for Lung Failure will review that information to determine whether you're a candidate for an on-site evaluation. If you qualify, you will be invited to the center for 2 days of outpatient testing, including

• Chest X-ray,
• Chest CT scan,
• Perfusion scan of lungs,
• Blood tests (alpha1 antitrypsin; Cotinine level),
• Complete pulmonary function test with lung volumes by plethsymography
• Room air arterial blood gas
• Dobutamine stress test of heart
• Cardiopulmonary exercise test

After the completion of these tests your review for the procedure will conclude with examination by a pulmonologist and surgeon who make final decisions about your eligibility to proceed with lung volume reduction surgery. All patients, whether surgical candidates or not, are evaluated for and prescribed a pulmonary rehabilitation program by the rehabilitation medical physician during their evaluation at the Center.

Patients accepted for surgery are referred to a 6-week program of outpatient pulmonary rehabilitation prior to surgery as well as a preoperative checkup in the final week of the program. At this time surgical consent is obtained, surgery scheduled and preoperative testing including an evaluation by an anesthesiologist is performed. All arrangements are made with the patient and his or her family and the staff at the Center for Lung Failure.

Lung Resection refers to the removal of a portion of the lung (lobectomy) or the whole lung (pneumonectomy) in patients with lung cancer, emphysema or other lung disorders. The procedure involves either an incision in the chest (open surgery), or a minimal access approach to remove the diseased area of the lung.

Lung transplantation offers a return to improved breathing and an excellent quality of life for patients suffering from advanced emphysema. NewYork-Presbyterian/Columbia is a leading center in the field of lung transplantation. In each of the last three years, more lung transplants were performed here than at any other transplant hospital in the tristate region. Medicare-approved as a center of excellence in lung transplantation, our outcomes are a testament to our expertise—with one-year survival following double-lung transplant exceeds 90%. This is far superior to the results of many highly regarded transplant programs in the country.

In addition to services and treatment available through the Department of Surgery, Columbia’s Division of Pulmonary, Allergy & Critical Care provides additional options for clinical trials and treatment for COPD.