Bronchoscopic interventions for severe emphysema: Where are we now?

Shah, Pallav L.; Slebos, Dirk‐Jan

doi:10.1111/resp.13835

Cited by 21 publications

(16 citation statements)

References 74 publications

(103 reference statements)

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“…All bronchoscopic procedures were conducted according to guidelines [19][20][21][22]. The emphysema score was evaluated by software based quantification of emphysema destruction at -950 hounsfield unit (StratX platform or VIDA Diagnostics).…”

Section: Methodsmentioning

confidence: 99%

Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.

et al. 2020

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BackgroundEndoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusion capacity of the lung for carbon monoxide (DLCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to DLCO for patients treated with ELVR.MethodsWe assessed DLCO at baseline and 3-months follow-up and compared pre- and postprocedural pulmonary function test (PFT), quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.Results121 patients treated with ELVR were analysed. 34 patients with a DLCO ≤20% and 87 patients with a DLCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV1) improved significantly only in patients with a DLCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (DLCO ≤20%: 17.6% versus DLCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.ConclusionsELVR improves lung function as well as quality of life in patients with DLCO >20% and DLCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low DLCO.

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Section: Methodsmentioning

confidence: 99%

Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.

et al. 2020

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“…lung cancer) and benign (e.g. post-lung transplant pathology and lung volume reduction) diseases [2,3]. They provide significant improvements in patient outcomes, but their long-term effectiveness and sustainability is hampered by the tissue reaction of the airways upon implantation.…”

Section: Introductionmentioning

confidence: 99%

Airway granulation response to lung-implantable medical devices: a concise overview

2021

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Increasing numbers of endoscopically implantable devices are implanted in the airways, such as airway stents, one-way valves and coils, to treat both malignant and benign diseases. They significantly improve patient outcomes, but their long-term effectiveness and sustainability is hampered by the reaction of the formation of granulation tissue. Factors including procedural-related tissue injury; micro-organism presence; device-related factors, such as the material, design and sizing in relation to the airway; and patient-related factors, including genetic susceptibility, comorbidities and medication use, might all effect the severity of the tissue response and the subsequent degree of granulation tissue formation. However, research into the underlying mechanism and risk factors is scarce and therefore our knowledge is limited. Joint efforts from the scientific community, both pre-clinical and clinical, are needed to gain a deeper understanding and eventually improve the long-term treatment effectiveness of lung-implantable devices.

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“…The development of emphysema is primarily attributed to prolonged exposure to noxious gases from sources such as smoking, exhaust fumes and air pollution [1,3]. COPD has remained an incurable condition, while limited treatment options exist to slow its progression and increase the quality of life [2,4]. diaphragmatic function.…”

Section: Introductionmentioning

confidence: 99%

Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction

et al. 2021

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Several bronchoscopic lung volume reduction (BLVR) treatments have been developed to reduce hyperinflation in emphysema patients. Lung bio-adhesives are among the most promising new BLVR treatment options, as they potentially provide a permanent solution for emphysematous patients after only a single application. To date, bio-adhesives have mainly been used as haemostats and tissue sealants, while their application in permanently contracting and sealing hyperinflated lung tissue has recently been identified as a novel and enticing opportunity. However, a major drawback of the current adhesive technology is the induction of severe inflammatory responses and adverse events upon administration. In our review, we distinguish between and discuss various natural, semi-synthetic and synthetic tissue haemostats and sealants that have been used for pulmonary applications such as sealing air/fluid leaks. Furthermore, we present an overview of the different materials including AeriSeal and autologous blood that have been used to achieve lung volume reduction and discuss their respective advantages and drawbacks. In conclusion, we describe the key biological (therapeutic benefit and biocompatibility) and biomechanical (degradability, adhesive strength, stiffness, viscoelasticity, tunability and self-healing capacity) characteristics that are essential for an ideal lung bio-adhesive material with the potential to overcome the concerns related to current adhesives.

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Bronchoscopic interventions for severe emphysema: Where are we now?

Cited by 21 publications

References 74 publications

Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.

Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.

Airway granulation response to lung-implantable medical devices: a concise overview

Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction

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Bronchoscopic interventions for severe emphysema: Where are we now?

Cited by 21 publications

References 74 publications

Endoscopic lung volume reduction with endobronchial valves in very lowDLCOpatients: results from the German Registry – Lungenemphysemregister e.V.

Endoscopic lung volume reduction with endobronchial valves in very lowDLCOpatients: results from the German Registry – Lungenemphysemregister e.V.

Airway granulation response to lung-implantable medical devices: a concise overview

Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction

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Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.

Endoscopic lung volume reduction with endobronchial valves in very lowD_LCOpatients: results from the German Registry – Lungenemphysemregister e.V.