# Exercise as it relates to Disease/Exercising with Emphysema: Bronchoscopic Lung Volume Reduction Benefits

This is an evaluation of article: Effect of Bronchoscopic Lung Volume Reduction on Dynamic Hyperinflation and Exercise in Emphysema. By Hopkinson, Toma, Hansell, Goldstraw, Moxham, Geddes, Polkey (2005). Created by u3140926

# Background
## Bronchoscopic Lung Volume Reduction

Bronchoscopic lung volume reduction is a non-surgical treatment that attempts to reduce the volume of hyperinflated lung segments. It is performed by inserting one-way valves into the airways. This allows gases and mucous to exit the targeted area, whilst denying the re-entry of air into the targeted lung segment. The outcome of this technique is partial collapsing of the affected area, which therefore reduces the volume of the lung. This can create significant improvements in lung functions, breathlessness and quality of life.

## Emphysema

Emphysema is a long term, progressive lung disease that causes breathlessness due to over-inflation of the alveoli. Emphysema is generally caused by smoking but can also be caused by air pollution, hereditary and gender factors. It is also classified as a chronic obstructive pulmonary disease (COPD). There is currently no cure for emphysema but it can be managed by using surgical techniques, medications and preventative lifestyle choices. Emphysema is diagnosed using a range of tests with the gold standard test being spirometry. It can also be diagnosed using other lung function tests, x-rays and CT scans.

### Symptoms Of Emphysema

* Breathlessness
* Cough and Phlegm production
* Fatigue
* Barrel-shaped chest
* Cyanosis (blue tinge in the skin)
* Susceptibility to chest infections.

### Treatments For Emphysema

As mentioned previously there is no cure for emphysema but management options are available:
* Cessation of smoking
* Respiratory rehabilitation programs
* Oxygen treatment
* Anti-inflammatory medications
* Stress management techniques
* Regular Exercise
* Surgical treatments
* Vaccinations.

# Where Is The Research From?

The study was conducted at the Respiratory Muscle Laboratory department of Royal Brompton Hospital, London, UK.

# What Kind Of Research Was This?

This was a cohort study testing the effects of bronchoscopic lung volume reduction on patients with emphysema. The patients entered the study if they have suffered from any of the following:
* Significant dyspnea
* Heterogeneous pattern of disease with a target area identified by Computed Tomography (CT) scanning and Ventilation Perfusion Scintigraphy
* Considered too great a risk for lung volume reduction surgery or declined surgery.

# What Did The Research Involve?

This study involved sixteen males and three females with a mean age of 58.7 who matched the above criteria. The subjects first performed an incremental cycling test to gather their baseline measurements. They were then fitted with the one-way valves to perform the Bronchoscopic Lung Volume Reduction (BLVR) procedure. Four weeks later, once the procedure had taken place, the subjects performed endurance cycle ergometry at 80% of the maximal workload achieved in the baseline tests with inspiratory capacity manoeuvres performed every minute to assess changes in end-expiratory lung volume. The peak values of each individual were also recorded. Leg and breathing discomfort were recorded using the Borg RPE scale.

# What Were The Basic Results?

This study showed improvements to the subjects test results across all measurements. Overall there was a 39% improvement in mean cycle endurance time, increasing from 227 seconds to 315 seconds. End-expiratory lung volume was reduced from 7.60 to 7.18L whilst at peak exercise. Changes in exercise capacity were not significantly associated with change in heart rate or VO2max. Improvements in endurance time was strongly associated with improved lung function. Overall the bronchoscopic lung volume reduction showed improvements in exercise capacities for people with emphysema.

## Limitations

Out of the group of subjects only two developed problems from the volume reduction but both of these cases were treated and their post procedure testing was postponed until they had recovered fully. Five subjects also showed symptoms of acute exacerbation after the procedure which was treated with oral antibiotics.

# What Conclusions Can We Take From This Research?

The study shows that the procedure improved mean exercise capacity and reduced dynamic hyperinflation in patients with emphysema. Improvements in exercise performance were clearly evident with 47% of patients making clinically significant improvements. Improvements were observed in the subjects end expiratory lung volume and endurance capacity after peak exercise workloads. Overall, bronchoscopic lung volume reduction can be seen to have positive benefits in patients with emphysema by increasing their lung efficiency.

# Practical Advice

Firstly, consult a general practitioner or respiratory specialist to get their recommendations on having the bronchoscopic lung volume reduction procedure. If it is then recommended to go ahead with the procedure it would be beneficial to do so as the results of this study have proven to show positive outcomes for the individual. Secondly, consult an exercise specialist to create an exercise program that will be well suited to the individuals needs. It is recommended to partake in preventative actions prior to the procedure to reduce the risk of developing emphysema. These actions may include the cessation of smoking, wearing face masks to avoid second hand smoke or air pollution and undertaking the recommended regular exercise guidelines daily.

# Further Information

* BLVR for Emphysema
* Bronchoscopic Lung Volume Reduction
* Emphysema

# References

* 1 2 3 4 5 6 7 Hopkinson N, Toma T, Hansell D, Goldstraw P, Moxham J, Geddes D et al. Effect of Bronchoscopic Lung Volume Reduction on Dynamic Hyperinflation and Exercise in Emphysema. American Journal of Respiratory and Critical Care Medicine. 2005;171(5):453-460.
* ↑ For Health Professional - Bronchoscopic Lung Volume Reduction [Internet]. Nickwilsmore.com.au. 2016 [cited 23 September 2016]. Available from: http://www.nickwilsmore.com.au/for-health-professional-BLVR
* ↑ George Schiffman F. What Is Emphysema? Symptoms, Treatment & Life Expectancy [Internet]. eMedicineHealth. 2016 [cited 23 September 2016]. Available from:http://www.emedicinehealth.com/emphysema/article_em.htm
* 1 2 3 [Internet]. 2016 [cited 23 September 2016]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/emphysema