Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data

Roodenburg, Sharyn A; Hartman, Jorine E.; Deslée, G.; Herth, Felix J.F.; Klooster, Karin; Sciurba, Frank C.; Shah, Pallav L.; Valipour, Arschang; Zoumot, Zaid; Slebos, Dirk‐Jan

doi:10.1159/000524148

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…The intention is to treat the most destroyed lobes bilaterally, in two stages with an interval of 4–8 weeks [ 113 ]. Depending on airway length, the interventionist can choose from three different sizes of coils (100 mm, 125 mm and 150 mm) and a median of 10 coils per procedure is used [ 114 ]. Production of the PneumRx endobronchial coil system was terminated in 2020, when the then manufacturer was acquired by Boston Scientific.…”

Section: Bronchoscopic Lung Volume Reductionmentioning

confidence: 99%

“…The latest trial, in which the target lobe was identified by quantitative CT analysis, was terminated prematurely by the study sponsor, but showed significantly better outcomes in coil-treated patients, for whom the decrease in RV and SGRQ score reached the MCID at 6 months ( table 2 ) [ 74 ]. The most recent meta-analysis used individual participant data from both single-arm and randomised trials (n=680) [ 114 ]. Based on this analysis, LVR-coil treatment resulted in a significant increase in FEV 1 at 3- and 6-month follow-up (+90 mL and +70 mL), a significant reduction in RV and SGRQ score at 3-, 6- and 12-month follow-up (−450 mL, −330 mL and −380 mL, and −12.3 points, −10.1 points and −9.8 points, respectively) and a significant increase in 6MWD at 3 months (+38 m).…”

Section: Bronchoscopic Lung Volume Reductionmentioning

confidence: 99%

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Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

Everaerts,

Vandervelde,

Shah

et al. 2023

Eur Respir Rev

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COPD is a highly prevalent, chronic and irreversible obstructive airway disease without curative treatment. Standard therapeutic strategies, both non-pharmacological and pharmacological, have only limited effects on lung function parameters of patients with severe disease. Despite optimal pharmacological treatment, many patients with severe COPD still have a high burden of dyspnoea and a poor quality of life. If these patients have severe lung emphysema, with hyperinflation as the driver of symptoms and exercise intolerance, lung volume reduction may be an effective treatment with a significant impact on lung function, exercise capacity and quality of life. Currently, different lung volume reduction approaches, both surgical and bronchoscopic, have shown encouraging results and have been implemented in COPD treatment recommendations. Nevertheless, choosing the optimal lung volume reduction strategy for an individual patient remains challenging. Moreover, there is still room for improving durability of effect and safety in all available procedures. Ongoing and innovative research is essential to push this field forwards. This review provides an overview of results and limitations of the current lung volume reduction options for patients with severe lung emphysema and hyperinflation.

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Section: Bronchoscopic Lung Volume Reductionmentioning

confidence: 99%

Section: Bronchoscopic Lung Volume Reductionmentioning

confidence: 99%

Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

Everaerts,

Vandervelde,

Shah

et al. 2023

Eur Respir Rev

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“…A meta-analysis of eight randomized trials using coils (680 patients) showed an improvement in FEV 1 and 6-MWD at three months; however, this was not sustained at 12-month follow-up. RV and SGRQ showed sustained benefits favoring coils at 12-month follow-up [51]. Only one multicenter trial is currently available that evaluated thermal vapor ablation showing a 14% improvement in FEV1 and -9.7 point improvement in SGRQ scoring with an increased risk AECOPD (24%) in the treatment group [52].…”

Section: Outcomes From Blvr Interventionsmentioning

confidence: 99%

Bronchoscopic lung volume reduction in emphysema: a review

Ravikumar,

Wagh,

Holden

et al. 2023

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic obstructive pulmonary disease (COPD) poses a substantial burden on the healthcare system and is currently considered the sixth leading cause of death in the United States. Emphysema, as evidenced by severe air-trapping in patients with COPD, leads to significant dyspnea and morbidity. Lung volume reduction via surgery or minimally invasive endobronchial interventions are currently available, which improve lung function and quality of life. Recent findings Newer studies have noted a survival benefit in patients post bronchoscopic lung volume reduction vs. those subjected to standard of care. The presence of collateral ventilation is one of the most common impeding factors to placing endobronchial valves, and if placed, these patients might not achieve lobar atelectasis; however, there are newer modalities that are now available for patients with collateral ventilation which we have described. Summary Combining standard of care treatment that includes smoking cessation, bronchodilators, preventive care including vaccinations, pulmonary rehabilitation, and endobronchial treatment using various interventions in decreasing hyperinflation improves quality of life and may improve survival and hence significantly reduce the burden of COPD on healthcare.

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“…In contrast to LVRS, eLVR has not been associated with increased perioperative risk or reduced survival after LTx [8]. In patients with severe emphysema, eLVR can be used to improve lung function, exercise capacity, and quality of life [9, 10]. The need for other therapeutic modalities including LTx is hereby delayed or can even be prevented in selected patients with persisting improvement after eLVR [9, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Lung Volume Reduction Prior to Lung Transplantation Does Not Increase Postoperative Pulmonary Complications

Kornyeva,

Semmelmann,

Ogutur

et al. 2023

Respiration

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Introduction: Lung transplantation (LTx) remains the only therapeutic option for selected patients with end-stage lung disease. In comparison to surgical lung volume reduction, few data exist on the risks and benefits of pretransplant endoscopic lung volume reduction (eLVR). Here, we investigate the risk of postoperative pulmonary complications (PPCs) after LTx in patients with emphysematous lung disease bridged with eLVR until transplantation. Methods: Eighty-two patients with emphysematous lung disease who underwent double-LTx (DLTx) were included and retrospectively evaluated. Statistical analysis was performed using SPSS and GraphPad Prism software. Results: 28/82 patients underwent eLVR prior to DLTx. eLVR patients spent comparable time on the waitlist; however, they were older at the time of DLTx (median 60 vs. 58 years, p = 0.02). Both groups showed comparable 90-day (92%) and long-term survival (eLVR 1-/5-/10-year survival: 92/88/77%, vs. control: 89/77/67%, p = 0.5). The odds for PPCs were similar in patients with and without eLVR (OR 0.7; 95% CI: 0.3–1.7), as well as major perioperative surgical and cardiovascular complications. In the entire cohort, we found ≥1 PPC to be a risk factor for death within 90 days (OR 9.7, 95% CI: 1.3–110). Among the PPCs, pneumonia (HR 4.6 95% CI: 1.1–14.9, p = 0.02) and ARDS (HR 11.2 95% CI: 1.6–229.2, p = 0.04) were identified as independent risk factors for reduced long-term survival. Conclusions: eLVR does not increase the risk for PPCs, surgical complications, or reduced survival after LTx in patients with emphysematous lung disease and can serve as a bridge to LTx.

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Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data

Cited by 14 publications

References 27 publications

Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

Bronchoscopic lung volume reduction in emphysema: a review

Endoscopic Lung Volume Reduction Prior to Lung Transplantation Does Not Increase Postoperative Pulmonary Complications

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