6/28/23, 11:22 PM NETT Pathway Feedback Search Clinical Topics Home Studies NETT NETT Disease Chronic obstructive pulmonary Trial question What is the role of lung volume-reduction surgery in patients with severe emphysema? Study design Multi-center Open label RCT Population Characteristics of study participants 39.0% female N = 1218 61.0% male 1218 patients (472 female, 746 male) Inclusion criteria: patients with severe emphysema who underwent pulmonary rehabilitation Key exclusion criteria: high risk for perioperative morbidity or mortality; disease unsuitable for lung volume reduction surgery; and medical conditions precluding the completion of trial Interventions N=608 lung volume-reduction surgery (goal to resect 20-35% of each lung, targeting the most diseased portion plus medical treatment) N=610 medical therapy (continued medical treatment without surgery) Primary outcome Improvement in exercise capacity at 24 months https://web.pathway.md/studies/reckTXBwBTHbAMZD2 1/2 6/28/23, 11:22 PM NETT Pathway 15.0 % 15 11.3 % 7.5 % Significant increase 3.8 % NNT = 8 3 0.0 % Lung volume-reduction surgery Medical therapy Significant increase in improvement in exercise capacity at 24 months (15% vs. 3%; OR 6.27, 95% CI 2.55 to 9.99) Secondary outcomes Significant increase in improvement in health-related quality of life (33% vs. 9%; OR 4.9, 95% CI 1.99 to 7.81) Significant increase in death at day 90 (7.9% vs. 1.3%; AD 6.6%, 95% CI 2.68 to 10.52) No significant difference in total deaths (25.8% vs. 26.2%; AD -0.4%, 95% CI -6.16 to 5.36) Conclusion In patients with severe emphysema who underwent pulmonary rehabilitation, lung volume-reduction surgery was superior to medical therapy with respect to improvement in exercise capacity at 24 months. Reference Fishman A, Martinez F, Naunheim K et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003 May 22;348(21):2059-73. Open reference URL https://web.pathway.md/studies/reckTXBwBTHbAMZD2 2/2