Antimuscarinic Bronchodilator Response Retained after Bronchoscopic Vagal Denervation in Chronic Obstructive Pulmonary Disease Patients

Koegelenberg, C F N; Theron, Jacques; Slebos, Dirk‐Jan; Klooster, Karin; Mayse, Martin L.; Gosens, Reinoud

doi:10.1159/000447641

Cited by 11 publications

(5 citation statements)

References 5 publications

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“…A small substudy of this cohort (n=7) showed that inflammatory markers measured in bronchial wash and brush specimens decreased 30 days after treatment, suggesting a mechanistic role of the treatment in modulating airways and possibly systemic inflammation [36]. Post hoc analyses of the same cohort showed that antimuscarinic medication provided a synergistic bronchodilatory effect to TLD alone, indicating the potential benefits of the combination of TLD treatment and inhaled long-acting muscarinic antagonists and highlighting the need for further research in this area [37]. The following clinical trial (NCT01716598; IPS-II) investigated the feasibility of performing the treatment in a single session and long-term safety [38].…”

Section: Studies In Copd Patientsmentioning

confidence: 89%

New bronchoscopic treatment modalities for patients with chronic bronchitis

et al. 2021

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Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.

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Section: Studies In Copd Patientsmentioning

confidence: 89%

New bronchoscopic treatment modalities for patients with chronic bronchitis

et al. 2021

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“…Recently, an animal study with efferent neuron staining showed absence of regeneration up to 640 days after TLD treatment [19]. Interestingly, the bronchodilator response to LAMA was maintained after TLD in COPD patients, and therefore TLD could be considered an add-on treatment instead of replacement of LAMA therapy [20].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings

et al. 2021

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Treatment options for severe asthma are limited, particularly in those patients who do not meet criteria for biologicals. Targeted lung denervation (TLD) is the bronchoscopic ablation of the peribronchial vagal nerve trunks to reduce cholinergic stimulation of airway smooth muscle and submucosal glands. This report describes the experience of the first 2 asthma patients treated with TLD worldwide. The participants were 54 and 51 years of age, and both had severe asthma (GINA 5) (FEV<sub>1</sub>: 53% and 113% of predicted; AQLQ scores: 5.3 and 4.4). Both participants were treated with TLD in a single day-case procedure under general anaesthesia. Lung function, health status, and adverse event data were collected at baseline and 12 months after TLD. No treatment-related serious adverse events were reported up to 12 months. Cough symptoms improved in both participants, and 1 participant reported a marked reduction in rescue medication use at 6 months. There were no significant changes in spirometry, lung volumes, or health status. In conclusion, TLD was performed safely in both participants, but more evidence is needed to clarify safety and efficacy of TLD in severe asthma. Therefore, further investigation of the treatment in severe asthma patients would be useful.

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“…The first-in-man clinical study of TLD,IPS-I, demonstrated that TLD provides a bronchodilator effect similar to anticholinergic therapy with a dose (power) dependency effect (240). TLD with an inhaled anticholinergic produced greater bronchodilator effect than either therapy alone (241). IPS-II demonstrated the feasibility and safety of a single whole lung TLD procedure (242).…”

Section: Targeted Lung Denervationmentioning

confidence: 99%

Interventional Bronchoscopy

Criner

Eberhardt

Fernández-Bussy

et al. 2020

Am J Respir Crit Care Med

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For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies and the ability to biopsy a lesion under direct visualization. The last 10-15 years has seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available, or are currently being investigated to treat a broad range of airway and lung parenchymal diseases such as asthma, emphysema, chronic bronchitis or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This state-of-the-art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.

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Antimuscarinic Bronchodilator Response Retained after Bronchoscopic Vagal Denervation in Chronic Obstructive Pulmonary Disease Patients

Cited by 11 publications

References 5 publications

New bronchoscopic treatment modalities for patients with chronic bronchitis

New bronchoscopic treatment modalities for patients with chronic bronchitis

Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings

Interventional Bronchoscopy

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