Endoscopic Lung Volume Reduction: An Expert Panel Recommendation – Update 2019

Herth, Felix J.F.; Slebos, Dirk‐Jan; Criner, Gerard J.; Valipour, Arschang; Sciurba, Frank C.; Shah, Pallav L.

doi:10.1159/000496122

Cited by 88 publications

(108 citation statements)

References 43 publications

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“…Bronchoscopic lung volume reduction (BLVR) is a valuable treatment option for patients with severe COPD and emphysema, aimed at reducing hyperinflation of the lung. 1 BLVR using endobronchial valves (EBV) and lung volume reduction coils (LVRC) have been studied most extensively and demonstrated to be effective, with an acceptable safety profile. 2 Dedicated patient selection for BLVR is essential in achieving clinically meaningful results after treatment.…”

Section: Introductionmentioning

confidence: 99%

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

Welling¹,

Hartman²,

Augustijn³

et al. 2020

COPD

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Purpose: Bronchoscopic lung volume reduction (BLVR) is a valuable treatment option for carefully selected patients with severe COPD. There is limited knowledge about the characteristics and outcomes of patients referred to a specialized center for BLVR. The study objectives were to investigate the selection rate for BLVR treatment in patients referred for this treatment and to investigate the differences between patients that were selected for BLVR and patients that were not. Patients and Methods: We performed a retrospective analysis of patients with severe COPD who were referred to our hospital to assess eligibility for BLVR treatment. Our parameters included demographics, comorbidity, chest computed tomography characteristics, reasons for rejection from BLVR treatment and patient survival. Results: In total, 1500 patients were included (mean age 62 years, 50% female and forced expiratory volume in 1 s 33% of predicted). Out of this group, 282 (19%) patients were selected for BLVR treatment. The absence of a suitable target lobe for treatment, an unsuitable disease phenotype and insufficient lung hyperinflation were the most important factors for not being selected. Patients that were selected for any BLVR option lived significantly longer than the group of patients that were not selected for BLVR (median 3060 versus 2079 days, P<0.001). Conclusion: We found that only a small proportion of patients that are referred for BLVR treatment is eligible for a BLVR treatment, indicating a need for both better referral tools and for the development of new therapies for this group of patients. Furthermore, our data suggest that selection for BLVR is associated with a significant survival benefit.

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Section: Introductionmentioning

confidence: 99%

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

Welling¹,

Hartman²,

Augustijn³

et al. 2020

COPD

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“…We performed a single center prospective study in which we included patients with severe emphysema (NCT03205826), who met the inclusion criteria for EBV treatment 5 . For safety reasons, patients that met the following criteria were excluded from participation: forced expiratory volume in one second (FEV 1 )<20%…”

Section: Methodsmentioning

confidence: 99%

“…To achieve EBV treatment benefit, interlobar collateral ventilation (CV) must be absent, as the presence of CV prevents the desired atelectasis of the target lobe 5 . anesthesia (GA), the measurement has not yet been validated under GA [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Collateral Ventilation Measurement Using Chartis

Welling

Klooster

Hartman

et al. 2019

Chest

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“…Therefore, in recent years, less invasive bronchoscopic lung volume reduction (BLVR) techniques have been developed and investigated thoroughly, among others in our centre, to achieve lung volume reduction in patients with severe emphysema and hyperinflation [31]. In general, patients with severe COPD and hyperinflation (residual volume (RV) >175% predicted or RV/total lung capacity (TLC) ⩾0.58) who are highly symptomatic despite optimal treatment are good candidates for BLVR [32]. To evaluate the possible treatment options in these patients, an HRCT scan should always be performed to assess the destruction of lung tissue, heterogeneity of emphysema and the fissure completeness.…”

Section: Treatable Trait: Hyperinflationmentioning

confidence: 99%

Treatment of severe stable COPD: the multidimensional approach of treatable traits

et al. 2020

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Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of “there is nothing to improve” any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care.

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Endoscopic Lung Volume Reduction: An Expert Panel Recommendation – Update 2019

Cited by 88 publications

References 43 publications

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

Collateral Ventilation Measurement Using Chartis

Treatment of severe stable COPD: the multidimensional approach of treatable traits

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