The National Emphysema Treatment Trial: Summary and Update

Emphysema is a chronic and debilitating disease in which affected patients must deal with diminished quality of life and poor functional status. Because contemporary medical therapy has had little impact on mortality rates, the National Emphysema Treatment Trial was designed to provide prospective randomized evidence for the efficacy of lung volume reduction surgery. This multicenter trial showed a mortality benefit and improved function in defined subgroups of patients based on the distribution of emphysema and baseline exercise tolerance. Patients with upper-lobe predominant disease and low exercise capacity achieved the most consistent gains in survival, exercise capacity, and quality of live in the long term with lung volume reduction surgery. Other subcategories of disease distribution and baseline exercise tolerance had variable results with surgery, emphasizing the importance of patient selection in achieving good outcomes.