It was not clear if the surgery helps the emphysema patients live longer. In patients with this condition, the walls between the tiny air sacs in the lungs, called alveoli, become damaged and the lungs are less able to expand and contract, making breathing difficult. The disease is chronic and progressive, leading to disability and early death. Around 82 percent to 90 percent of emphysema cases are due to chronic smoking. The non-surgical treatment involves oxygen treatments, smoking cessation and medicines to open the lung's airwaves called bronchodilators.
Many patients become unresponsive to the medications.
Experts estimate that 200,000 to 400,000 Americans with emphysema might benefit from the surgery. It was 1994 when Cooper first reported the outcome of a lung reduction trial of 20 patients at the American Association of Thoracic Surgery meeting. The surgery caught on and Medicare paid for the procedure, explains Cooper, but the agency stopped reimbursing it because the hospitals were not choosing the right candidates for the procedure and were not providing appropriate follow-up care and too many people were dying. As a result, in 1996, the National Heart Lung and Blood Institute in collaboration with the Health Care Financing Administration, the agency that runs Medicare, developed the National Emphysema Treatment Trial. The government pays for the subjects' participation.