New principles for the treatment of diffuse pulmonary emphysema

Emphysema is due to destruction of lung tissue but the main cause of the dyspnoea is a diminished elasticity of the lungs. Medical therapy, such as bronchodilation, corticosteroids, and treatment of intercurrent infections, can give temporary relief. Long-term oxygen treatment can improve and prolong life in patients with severe epmphysema. Lung transplantation is a final option in selected patients. Rehabilitation including exercise training will cause increase in maximal exercise tolerance and decrease of dyspnoea, and thereby an improvement of quality of life. In recent years surgical reduction of the lung volume has been reintroduced and in selected cases given dramatic results. The goal is to reduce the volume in both lungs with about 30%. Depending on the distribution of the emphysema, pieces of the upper or lower lobes will be removed. Sternotomy or bilateral thoracoscopy, using staplers, are the most common methods. Short-term results are good, with an improvement of FEV1 of 22-96%, improved arterial oxygen pressure, and a radical improvement of life quality. The impact on the daily life of the patient can be dramatic. The long-term results are still not well known, and many questions remain before volume reduction surgery can be regarded as an established form of treatment for emphysema, and randomized studies are badly needed.