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The New York Optimist
Quality of Life Innovations from the Columbia University Department of Surgery

Advanced Emphysema

Physicians in the Section of General Thoracic Surgery and the Center for Chest Disease at Columbia University
Medical Center are improving the quality of life for people with advanced emphysema.

Chronic Obstructive Pulmonary Disease (COPD), refers to a group of diseases that share a common feature—
difficulty in expelling air from the lungs. The three diseases most commonly labeled COPD are asthma, chronic
bronchitis, and Emphysema.

Emphysema occurs when the small air sacs of the lung break down. The collapse of these sacs leads to trapped
air and hyperinflation (overfilling of the chest with air). Breathing becomes increasingly difficult, causing
shortness of breath, fatigue, and diminished exercise capacity.

Emphysema Risk Factors

The highest risk for emphysema is heavy smoking, although not all people who smoke heavily develop
emphysema, and genetic researchers believe that genes are likely involved in determining why some develop the
disease and some do not.
Treatment of Emphysema

Although emphysema can be managed with a combination of medication and exercise, in patients with advanced emphysema, this therapy may not be
sufficient. Lung Volume Reduction Surgery (LVRS) is the gold standard in treating advanced emphysema, and in addition to oxygen therapy, the only
treatment shown to prolong survival. By removing the damaged portions of lung tissue, the procedure enables the remaining lung tissue to function more
effectively. After the procedure, patients experience an increase in ability to exercise, improved survival, and an overall improvement in quality of life.

The Section of Thoracic Surgery at Columbia University has been a leader in LVRS since 1994, with success rates of over 90%. In most cases, surgeons at
Columbia perform LVRS using video-assisted thoracoscopic techniques through minimally invasive incisions. The procedure is very safe and effective, with
no procedure-related deaths occurring at the center in over twelve years.

To expand treatment options for more patients, the Center for Chest Disease at Columbia is currently investigating devices that could achieve LVRS-like
results without surgery. The investigational devices are inserted through the windpipe into the lungs. These devices are currently in late clinical trials.