Background In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume reduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise tolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an endobronchial valve has not been attempted in patients with giant bullae. Case presentation We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous emphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large bullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually worsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to treat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA) confirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial valve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patient’s symptoms and quality of life improved markedly. Conclusion This case supports recent suggestions that BLVR can serve as a good alternative treatment for appropriately selected patients.

Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown etiology. In several randomized clinical trials, and in the clinical practice, pirfenidone is used to effectively and safely treat IPF. However, sometimes it is difficult to use the dose of pirfenidone used in clinical trials. This study evaluated the effects of low-dose pirfenidone on IPF disease progression and patient survival in the real-world. Methods This retrospective, observational study enrolled IPF patients seen at the time of diagnosis at a single center from 2008 to 2018. Longitudinal clinical and laboratory data were prospectively collected. We compared the clinical characteristics, survival, and pulmonary function decline between patients treated and untreated with various dose of pirfenidone. Results Of 295 IPF patients, 100 (33.9%) received pirfenidone and 195 (66.1%) received no antifibrotic agent. Of the 100 patients who received pirfenidone, 24 (24%), 50 (50%), and 26 (26%), respectively, were given 600, 1200, and 1800 mg pirfenidone daily. The mean survival time was 57.03 ± 3.90 months in the no-antifibrotic drug group and 73.26 ± 7.87 months in the pirfenidone-treated group (p = 0.027). In the unadjusted analysis, the survival of the patients given pirfenidone was significantly better (hazard ratio [HR] = 0.69, 95% confidence interval [CI]: 0.48–0.99, p = 0.04). After adjusting for age, gender, body mass index, and the GAP score [based on gender (G), age (A), and two physiological lung parameters (P)], survival remained better in the patients given pirfenidone (HR = 0.56, 95% CI: 0.37–0.85, p = 0.006). In terms of pulmonary function, the decreases in forced vital capacity (%), forced expiratory volume in 1 s (%) and the diffusing capacity of lung for carbon monoxide (%) were significantly smaller (p = 0.000, p = 0.001, and p = 0.007, respectively) in patients given pirfenidone. Conclusions Low-dose pirfenidone provided beneficial effects on survival and pulmonary function decline in the real-world practice.

Background: Although respiratory tract infection is one of the most important trigger factors for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), there are limited data on the epidemiologic patterns of microbiology in South Korea.Methods: A multicenter observational study was conducted in 28 hospitals in South Korea between January 2015 and December 2018. Adult COPD patients with moderate to severe acute exacerbations were eligible for the present study. They underwent all conventional tests to identify etiologic microbiologic pathogens. The primary outcome was the percentage of different microbiological pathogens that caused AE-COPD. Comparative microbiological analysis was performed between the patients with asthma-COPD overlap (ACO) and pure COPD. Results:We included 1,186 patients with AE-COPD. Pure COPD patients were 87.9% and ACO patients were 12.1%. Nearly half of the patients used an ICS-containing regimen and one-fifth used systemic corticosteroids. Among them, respiratory pathogens were found in 55.3%. Bacteria and viruses were found in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple 7 bacterial infections were more likely found in ACO compared to pure COPD (8.3% vs 3.6%, p-value=0.016). Conclusion:Distinct microbiological patterns were identified in patients with moderate to severe AE-COPD in South Korea. These findings may improve evidence-based management for AE-COPD and become the basis for further research related with infectious pathogens in COPD patients.