STUDY PROTOCOL Design of the randomized h s

Full list of author information is available at the end of the articleBackground In 2004, the World Health Organization estimated that 64 million people have chronic obstructive pulmonary dis-ease (COPD) [1]. Emphysema, a subset of COPD, dam-ages the alveoli causing hyperinflation and reduced gas exchange resulting in a decrease in pulmonary function, shortness of breath and a decline in the patient’s quality of life. Although there is presently no cure for this progressive disease, data from the randomized National Emphysema Treatment Trial (NETT) identifies lung volume reduction surgery (LVRS) as an effective treat-ment for patients with emphysema [2]. Patients with upper lobe predominant emphysema (ULPE) and low ex-ercise capacity had the best results with LVRS. By redu-cing the more diseased upper lobe, hyperinflation is reduced as measured by residual volume reduction and the better functioning lower lobes are preserved. Although results from the NETT demonstrated an im-provement in pulmonary function such as FEV1, exercis