Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony

Chest. 2015 Jul;148(1):185-195. doi: 10.1378/chest.14-2380.


Background: Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known.

Methods: We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months after LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen [Vab]) and phase shift angles (θ) calculated for the asynchrony between Vrc,p and Vrc,a (θRC), and between Vrc,a and Vab (θDIA).

Results: Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°). Between-group difference in the change in θRC and θDIA during quiet breathing following treatment was 44.3° (95% CI, -78 to -10.6; P = .003) and 34.5° (95% CI, 1.4 to 67.5; P = .007) toward 0° (representing perfect synchrony), respectively, favoring the LVR group. Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.

Conclusions: Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bronchoscopy*
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / physiology
  • Humans
  • Male
  • Middle Aged
  • Plethysmography, Impedance
  • Pneumonectomy*
  • Pulmonary Emphysema / complications
  • Pulmonary Emphysema / physiopathology*
  • Pulmonary Emphysema / surgery*
  • Residual Volume / physiology
  • Respiratory Mechanics / physiology*
  • Thoracic Wall / physiopathology*
  • Treatment Outcome