Emphysema | National Treatment Trial | Evaluation Program | Treatment Options | Patient Success Story | Education Resources
Dorris Harris exercises at Kernan Hospital as a participant in the hospital's pulmonary rehabilitation program.
Dorris Harris first realized she had emphysema when she suddenly lost her breath at work.
"I was sitting at my desk and I just couldn't breathe," recalled Harris. "I had stopped smoking that November. I was taken to the hospital and they diagnosed me with emphysema." That was in 1988.
Harris continued to work as a Baltimore District Court supervisor until 1991, when it became almost physically impossible for her to continue. "It was difficult for me to get up the steps at work and at my house," she said. It became increasingly hard for Harris to do her job, which required a good deal of walking.
And despite the fact that she exercised and took care of herself, her emphysema kept getting worse.
"Even though I had been exercising all along I noticed I was starting to take a downturn," said Harris. "I would faithfully exercise, sometimes five days in a row. Even with the exercise I could tell that I was losing ground."
Then she heard about the Lung Volume Reduction Surgery and the National
Emphysema Treatment Trial (NETT) on a television newscast.
"At the time transplant wasn't an option I was ready for so I did research
on Lung Volume Reduction and decided it was for me," Harris said.
Non-Surgical LVR Treatment for Emphysema Study (News Release)
NETT, a five-year, multi-center, randomized study, was designed to determine what is the best treatment for people with severe emphysema: medical management alone, which typically involves medication and rehabilitation; or medical management plus lung volume reduction surgery (LVRS), in which damaged portions of each lung are removed.
The study began in 1996 as a cooperative effort between the NHLBI and the Centers for Medicare and Medicaid Services. In 1997, the University of Maryland was awarded a National Institutes of Health (NIH) grant to become one of the 17 centers of excellence in the NETT. Patient screening for entry into the study began in the fall of 1997 and continued until April 2002; the last patient was randomized in July 2002. The results of the study were published in the May 22, 2003 edition of the New England Journal of Medicine.
Results indicated that on average, patients who undergo LVRS with medical therapy are more likely to function better after two years and do not face an increased risk of death, compared to those who received medical therapy only. The study did indicate a survival advantage for people with both predominantly upper-lobe emphysema and low baseline exercise capacity (measured by the bicycle CPET test after pulmonary rehabilitation).
Emphysema is a progressive, chronic, and disabling lung condition that affects 2 million Americans, primarily people over age 50 who are current or former cigarette smokers.
With emphysema, breathing becomes difficult as the air sacs (alveoli) in the lungs are damaged, leading to large holes in the lung, obstructed airways, trapping of air, and difficulty exchanging oxygen because of reduced elasticity of the lungs.
Emphysema costs more than $2.5 billion in annual health care expenses and causes or contributes to 100,000 deaths in the U.S. each year. While it cannot be cured, emphysema can be managed through a healthy lifestyle that incorporates physical activity and good nutrition. Treatment strategies focus on helping the person to live as comfortably as possible, providing relief of symptoms, and preventing any further progression. Further progression cannot totally be stopped and is estimated to be about 10 percent deterioration per year.
Current treatments include:
With lung volume reduction surgery, 25 to 30 percent of the most damaged regions of each lung are removed. Doctors believe that by surgically removing the useless tissue, air will move in and out of the remaining lung more readily, thereby easing symptoms associated with advanced emphysema.
From the beginning, Harris said, "It seemed like it was meant for me to do this [NETT]." Since she lived in Baltimore, she called the Medical Center to inquire about the trial. Harris passed all the physical exams necessary to be eligible for the randomized trial. She started the process in February of 1998 and was randomized in July of that year.
All participants in the study were required to receive six to 10 weeks of pulmonary rehabilitation prior to randomization. After rehabilitation, participants were randomly divided into two groups: those who were selected to receive LVRS in addition to medical therapy, and those who would continue receiving medical therapy only.
"I was fortunate," said Harris. "I was the second person in the state of Maryland to be selected for the surgery."
Those patients randomized to surgery were, at the same time, randomized into one of two surgical approaches. The first was the standard approach of opening through the chest (median sternotomy), where surgeons make an incision in the middle of the chest and open ribs.
The other, less invasive approach is thoracoscopy, a minimally invasive technique that involves making two or three small incisions (approximately one inch) in between the ribs. Once at the lung, the surgery is identical -- as much as 30 percent of the lung is removed and the lung is then resealed with a stapling device.
Harris was chosen for the standard approach, and she had the surgery on August 6, 1998.
After her surgery, Harris's life improved. "I think it was successful," said Harris. "I still feel better and I honestly believe the surgery had a lot to do with that."
Before the surgery, Harris couldn't get to church because she couldn't walk up the steps. "Now I go to church, I can make my bed, walk on level surface," she said. "I didn't ask for much, just to do the things I like to do, like shopping, cooking and driving." Now she can do all of those activities, but she especially enjoys food shopping. " I love going to the supermarket," remarked Harris. "I can stay for three hours at a time. I go up and down every aisle."
And even though her current pulmonary function and breathing tests show that her numbers are now back to where they were prior to the surgery she still thinks the operation was successful. "I still am able to do more than I could before the surgery," Harris said. "Numbers don't matter. I still have bad days, I still get shortness of breath but I would do it again."
After the study, patients are followed for five years through visits, phone calls and letters. Harris was followed up with periodic visits for five years following the operation. The last visit, her 60th month visit, was July 28, 2003.
One of the goals of the trial was to help patients make lifestyle changes, which include rehabilitation at least three days a week for the rest of their lives. To that end, Harris still voluntarily participates in the pulmonary rehabilitation program at Kernan Hospital, designed specifically for emphysema patients. That's because she firmly believes in the importance of exercise and taking care of herself.
"I honestly believe that even after treatment you definitely have to keep exercising and taking your medication," stressed Harris. "Because of my emphysema, I exercise. If you sit and do nothing you go downhill fast. But if you exercise it just may prolong your life."
By Michelle W. Murray
University of Maryland Medical System Web Site Writer
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