National Emphysema Treatment Trial (NETT)

Columbia Presbyterian surgeons are pioneers in the treatment of emphysema and end-stage lung disease using lung volume reduction surgery (LVRS). An advance for patients with COPD, this approach is designed for those with pure emphysema associated with severe disability, hyper-inflated chests, and heterogeneous disease within the lungs.

Having performed over 200 of these procedures, Columbia surgeons are now participating in the seven-year NIH NETT trial (ending in 2005) on LVRS. Surgical mortality has been 5 percent. Patients show improvement in walking distance, dyspnea and pulmonary function, testing in the 35 to 50 percent range post operatively. Columbia is the only institution in the New York City metropolitan area to participate in NETT.

What Is NETT?

In December 1995, citing a lack of data and raising concerns over safety and effectiveness, Medicare halted payments for lung volume reduction surgery. In the spring of 1996 the National Institutes of Health and Medicare opened the National Emphysema Treatment Trial (NETT), a 7-year multi-center randomized clinical study comparing the best medical therapy against surgical therapy for emphysema. Medicare will now cover the cost of lung volume reduction surgery only for patients enrolled in the National Emphysema Treatment Trial (NETT).

In this trial, researchers are comparing the benefits and risks of 1) medical treatment for emphysema and 2) medical treatment plus lung volume reduction surgery. People who participate in NETT will be randomly assigned to one of the two treatment groups. The NETT staff will follow patients' response to treatment for up to five years.

NETT Costs

Medicare helps cover the costs of the doctor's visits and tests for those members enrolled in NETT. (Outside of this study, Medicare will not pay for lung volume reduction surgery.) If a patient is assigned to surgery, Medicare will help pay hospital costs. Patients enrolled are responsible for all deductibles and co-payments. All Medicare limits and restrictions also apply. If a patient has private insurance to supplement the Medicare coverage (a "Medigap policy"), this insurance will likely help cover costs. Patients enrolled in NETT are responsible for costs for travel and lodging; these are not covered by the trial.

Participation in NETT

Evaluation

If you are interested in being evaluated for NETT, please call the Center for Lung Failure at Columbia Presbyterian Medical Center, 212.305.1158, to obtain a patient questionnaire. Your evaluation at the Center starts when you forward the following for review before you are invited in for an evaluation.

You will be requested to mail the following to the Center for review:

	Completed questionnaire
	Pulmonary function test
	Chest x-ray (film & report)
	Pulmonologist's notes

This information will be reviewed by the staff to see whether you are a likely candidate for the trial. After this review, the Center staff will contact you by phone to set up an on-site evaluation.

If you are interested in taking part in NETT, you must go through a series of screening tests to learn if you qualify. This process involves must be done on-site at Columbia Presbyterian Medical Center. Screening requires four days of testing as an outpatient. Evaluation includes:

	History & physical examination by a pulmonologist
	CT scan of chest
	Chest X-ray
	Blood tests including alpha 1 antitrypsin and cotinine levels
	Electrocardiogram
	Pulmonary function tests with lung volumes by plethsymography
	Dobutamine thallium stress tests of the heart
	Echocardiogram
	Cardiopulmonary exercise tests
	Oxygen titration
	Two six-minute walks
	Evaluation by rehabilitation physician and physical therapist
	Nutritional evaluation
	Psychiatric evaluation
	Quality of life questionnaires

Treatment Protocol for NETT Participants