Effect of bullectomy on diaphragm strength.

Surgical removal of bullous lesions in selected patients with chronic obstructive pulmonary disease may significantly improve lung function, gas exchange, and functional status and reduce dyspnea. Proposed mechanisms by which bullectomy may produce these beneficial effects include (1) improving ventilation and perfusion matching by allowing compressed viable lung to re-expand and participate in gas exchange; (2) restoring outward elastic tension on small airways, thereby reducing airways obstruction; and (3) reducing end-expiratory lung volume, thereby diminishing the adverse effects of chronic hyperinflation on chest wall elastic recoil and inspiratory muscle force generation. In this report, we demonstrate the effect of bullectomy on transdiaphragmatic pressure generation, gas exchange, and exercise capacity in a patient with severe bullous emphysema who underwent unilateral bullectomy.