Bronchoscopic thermal vapour ablation therapy in the management of heterogeneous emphysema

Abstract

The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema.44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40-75 yrs, forced expiratory volume in 1 s (FEV1) 15-45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) o1.2. Changes in FEV1, St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA.At 6 months, mean¡SE FEV1 improved by 141¡26 mL (p,0.001) and residual volume was reduced by 406¡113 mL (p,0.0001). SGRQ total score improved by 14.0¡2.4 points (p,0.001), with 73% improving by o4 points. Improvements were observed in 6MWD (46.5¡10.6 m) and mMRC dyspnoea score (0.9¡0.2) (p,0.001 for both). Lower respiratory events (n511) were the most common adverse event and occurred most often during the initial 30 days.BTVA therapy results in clinically relevant improvements in lung function, quality of life and exercise tolerance in upper lobe predominant emphysema.

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

“…A single-arm multicenter study of 44 patients with upper lobe emphysema indicated that patients receiving unilateral BTVA had an improved FEV 1 of 140.8 mL (p < 0.001) after 6 months, and 58% of patients had 12% improvement in their FEV 1 (69). However, the inflammatory reaction causes most patients to develop complications such as a fever, cough, sputum, and hemoptysis in the 4 weeks after the procedure; the inflammatory response gradually subsides after 12 weeks but it prolongs hospitalization.…”

Lung Volume Reduction in Pulmonary Emphysema from the Radiologist’s Perspective

“…The onset of effect is therefore delayed compared to the other ELVR procedures, with maximum effect not appearing until after 8 to 12 weeks. In two prospective uncontrolled studies, Snell et al (SGRQ) [30,31] reported therapeutic success similar to that achieved with EBV, specifically a volume reduction of the target area by up to 48 % and a significant improvement of lung function and quality of life (SGRQ) [30,31]. A typical post-interventional complication of BTVA is an overreaching inflammation accompanied by flu-like symptoms.…”

Bronchoscopic lung volume reduction for emphysema: where next?

“…Also in this issue of the ERJ are combined data from two studies using unilateral bronchoscopic thermal vapour ablation (BTVA) to achieve volume reduction [19]. SNELL et al [19] report outcomes for 44 patients with heterogeneous emphysema treated in two open-label studies (combined data set) with endobronchial application of steam.…”

“…SNELL et al [19] report outcomes for 44 patients with heterogeneous emphysema treated in two open-label studies (combined data set) with endobronchial application of steam. The application of thermal energy leads to focal inflammation that progresses to fibrosis and contraction of lung tissue.…”