Physiological assessment and cardiopulmonary exercise testing

Walker, Paul P., West, Malcolm, Grocott, Michael P.W. and Jack, Sandy (2013) Physiological assessment and cardiopulmonary exercise testing. In, Gridelli, C. and Audisio, R. (eds.) Management of Lung Cancer in Older People. Springer London, pp. 33-52. (doi:10.1007/978-0-85729-793-8_3).

Abstract

There have been significant advances in the management and treatment of lung cancer over the last 10–20 years, but surgical resection remains the primary treatment that results in cure and long-term survival. However, factors that predispose to the development of lung cancer also increase the incidence of chronic obstructive pulmonary disease. Physiological testing before lung cancer surgery is important, and every patient should undergo detailed lung function testing including measurement of the transfer factor for carbon dioxide (TLCO). Patients with a predicted postoperative FEV1 and TLCO of <40 % predicted should undergo cardiopulmonary exercise testing to further detail their risk status. Only in this way can a fully informed decision take place between the patient and surgeon as to the best treatment which not only attempts “cure” but also minimizes postoperative mortality while delivering acceptable postoperative breathlessness and quality of life. Age alone should never be used to deny surgery and function should be formally assessed as we have detailed.

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Contributors

Author: Malcolm West

Author: Michael P.W. Grocott

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