Nihon rinsho. Japanese journal of clinical medicine
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Lung volume reduction surgery (LVRS) for severe pulmonary emphysema was started more than 10 years ago. However, its indication and durability of effects had not been clear. The National Emphysema Treatment Trial (NETT) defined patients at high risk of death after LVRS and subgroups of patients with severe emphysema in whom LVRS improved survival and function. ⋯ However, only one-fourth of LVRS candidates are belonging to such a preferable subgroup. Although most of the patients with severe pulmonary emphysema are over 60 years old in Japan, candidates for lung transplantation are limited under 60. Under such a condition, only two patients with severe pulmonary emphysema have undergone lung transplantation in Japan.
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In the guideline proposed by WHO (GOLD) or by the Japanese Respiratory Society (RS), the diagnosis of COPD is simply made when FEV1/FVC (FEV %) of a given subject after inhalation of short-acting bronchodilator is below 70%. On the other hand, on grounds of measured FEV1/predicted FEV (%FEV1), the disease severity of COPD is categorized into four stages including I (mild), II (moderate), III (severe), and IV(very severe). ⋯ However, the above-mentioned criteria have many impediments as they are too simple for diagnosing and classifying COPD with a complicated pathophysiology. In this paragraph, the attempt is made not only to comment on the diagnosis criteria and classification of disease severity of COPD provided in GOLD and JRS guidelines but also to investigate the details of the impediments existing in both guidelines.
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Oxygen therapy is one of the principal non-pharmacologic treatments for severe chronic obstructive pulmonary disease (COPD) patients. Home oxygen therapy(HOT), or long-term oxygen therapy(LTOT) for 15 hours or more per day, can improve the survival rate of severe COPD patients with beneficial effects on hemodynamic state, hematological characteristic, exercise capacity, lung mechanics, and mental state. ⋯ The induction of oxygen therapy needs evaluations of oxygen desaturation during exercise and sleep as well as hypoxia at rest. It also required to consider CO2 narcosis.