Lung volume reduction surgery (LVRS) is a recent addition to the treatment options for selected patients with pulmonary emphysema, a condition affecting approximately 1.65 million people in the United States.<sup>81American Thoracic Society Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: Definitions, epidemiology, pathophysiology and staging Am J Respir Crit Care Med 1995 ;  152 : 578-584

Cliccare qui per andare alla sezione Riferimenti</sup> Emphysema, asthma, and chronic bronchitis are three forms of chronic obstructive pulmonary disease (COPD), each characterized to some degree by shortness of breath and airflow limitation. Whereas asthma is a reversible condition characterized by bronchospasm, and chronic bronchitis is accompanied by a productive cough, these three forms of obstructive lung disease often overlap in the same patient.<sup>81American Thoracic Society Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: Definitions, epidemiology, pathophysiology and staging Am J Respir Crit Care Med 1995 ;  152 : 578-584

Cliccare qui per andare alla sezione Riferimenti</sup> Emphysema, specifically, is a chronic, slowly progressive disease, defined by the American Thoracic Society as “a condition of the lung characterized by abnormal, permanent enlargement of the air spaces distal to the terminal bronchiole, accompanied by destruction of their walls.”<sup>80American Thoracic Society Chronic bronchitis, asthma and pulmonary emphysema: A statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Diseases Am Rev Respir Dis 1962 ;  85 : 762-768

Cliccare qui per andare alla sezione Riferimenti</sup> Some forms of emphysema, such as ⍺₁-antiprotease deficiency are inherited, but most pulmonary emphysema develops secondary to cigarette smoking. This chronic and irreversible illness is the source of considerable patient morbidity and medical expense, through medical therapy, supplemental oxygen therapy, pulmonary rehabilitation, and hospitalization for disease exacerbation and superimposed infections.

Approximately two thirds of the nearly 12,000 patients requiring daily mechanical ventilator support via tracheostomy for respiratory failure in the United States each year have COPD as the etiology, at a yearly cost of $2 billion.<sup>38Indihar F.J. A 10-year report of patients in a prolonged respiratory care unit Minn Med 1991 ;  74 : 23-27

Cliccare qui per andare alla sezione Riferimenti</sup> Once requiring mechanical ventilation, the prognosis for patients with COPD is significantly worse than that for patients with other causes of respiratory failure.<sup>94Votto J., Brancifort J.M., Scalise P.J., e al. COPD and other diseases in chronically ventilated patients in a prolonged respiratory care unit: A retrospective 20-year survival study Chest 1998 ;  113 : 86-90 [cross-ref]

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Until the advent of LVRS, lung transplantation was the only treatment available to patients with severe emphysema failing medical therapy. Unfortunately, because of the limited availability of lung allografts and frequency of chronic allograft rejection, this is not a viable option for many patients. <sup>32Gross C., Savik K., Bolman R., e al. Long-term health status and quality of life outcomes of lung transplant recipients Chest 1995 ;  108 : 1587-1593 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 88Sundaresan S., Trulock E., Mohanakumar T., e al. Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation Ann Thorac Surg 1995 ;  60 :

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