Bronchoscopic Treatment of Emphysema: State of the Art

Abstract

In recent years, different bronchoscopic techniques have been proposed for the treatment of emphysema, with the aim of obtaining the same clinical and functional advantages of lung volume reduction surgical techniques while reducing risks and costs. Such techniques can be classified into: methods employing devices that block the airways (e.g. spigots and unidirectional valves), methods that have a direct effect on the lung parenchyma (polymeric lung volume reduction, coils and thermal vapor ablation) and procedures that facilitate the expiration of trapped air from the emphysematous lung (airway bypass). This review aimed to evaluate the indications, outcomes and safety of the different techniques, based on the evidence from the available literature. Results obtained by these methods are encouraging, but they are still based mainly on studies with small groups of patients. However, several trials are ongoing and in the near future we will acquire more knowledge which should lead to a better optimization of these procedures. Meanwhile, the bronchoscopic treatment of emphysema cannot yet be considered a standard of care and patients should be treated in the context of clinical trials or controlled registries, with well-defined programs of evaluation and follow-up.

Bronchoscopic treatment options for chronic obstructive pulmonary disease

“…According to their mechanism there are three main groups of BVR techniques: methods that have direct effect on lung parenchyma (polymeric lung volume reduction, coils and thermal vapor ablation), methods that facilitate the expiration of trapped air from the emphysematous lung (airway bypass) and methods employing devices that block the airways (spigots and unidirectional valves) [10]. Patients with diagnosis of hyperinflation in chest X Ray or pulmonary computed tomography (CT), forced expiratory volume in one seconds (FEV 1 ) values less than 500mL, arterial partial oxygen pressure (PaO 2 ) less than 50 mmHg and arterial carbon dioxide partial pressure (PaCO 2 ) more than 50 mmHg are candidates for BLVR procedure.…”

“…zephyr valves are made of nitinol (nickel titanium) mesh covered by silicone and contains double silicone membrane inside that opens during expiration and closes during inspiration [10]. zephyr valves are available in two sizes, one for segmental (4.0-9.0 mm) and one for lobar bronchi (5.5-8.5 mm), anchorage of the valve to the airway is facilitated by the irregular surface and self-expanding strength of the mesh.…”

“…Intrabronchial valves are umbrella-shaped devices made of a nitinol mesh covered by a polyurethane membrane [10]. The valve is secured to the airway wall by hook-like anchors.…”

“…These products (hydrogel) are developed to obtain atelectasis and fibrosis of the lung parenchyma [10]. Biological substances have now replaced by synthetic polymeric foam (Aeris therapeutics), the foam flows into the peripheral airways and acts as a glue that seals the target regions with consequent atelectasis [10].…”

“…Biological substances have now replaced by synthetic polymeric foam (Aeris therapeutics), the foam flows into the peripheral airways and acts as a glue that seals the target regions with consequent atelectasis [10]. It blocks inter-alveolar as well as bronchiolar-alveolar collaterals, thus it will negate the effect of collateral ventilation.…”