Lung Volume Reduction in Pulmonary Emphysema

Abstract

Severe emphysema with hyperinflation presents a therapeutic challenge. Inhaled medication has limited efficacy in individuals with mechanical constraints to the respiratory pump and impaired gas exchange. Lung volume reduction surgery (LVRS) reestablishes some semblance of normal physiology, resecting grossly expanded severely diseased tissue to restore the function of compromised relatively healthy lung, and has been shown to significantly improve exercise capacity, quality of life, and survival, especially in individuals with upper-lobe predominant emphysema and low-baseline exercise capacity, albeit with higher early morbidity and mortality. Bronchoscopic lung volume reduction achieved by deflating nonfunctioning parts of the lung is promoted as a less invasive and safer approach. Endobronchial valve implantation has demonstrated comparable outcomes to LVRS in selected individuals and has recently received approvals by the National Institute of Clinical Excellence in the United Kingdom and the Food and Drug Administration in the United States of America. Endobronchial coils are proving a viable treatment option in severe hyperinflation in the presence of collateral ventilation in selected cases of homogeneous disease. Modalities including vapor and sealant are delivered using a segmental strategy preserving healthier tissue within the same target lobe-efficacy and safety-data are, however, limited. This article will review the data supporting these novel technologies.

Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia

“…Pulmonary function tests (FEV1, RV, diffusion capacity of carbon monoxide [DLCO]), 6-MWT, the modified Medical Research Council (mMRC) dyspnoea scale, the COPD assessment test (CAT), St. George's Respiratory Questionnaire (SGRQ), and adverse events after ELVR were evaluated at baseline and 3-month follow-up to assess the efficacy and safety of the procedure. All bronchoscopic procedures were performed according to pre-existing guidelines [14][15][16][17]. Pulmonary function tests, including spirometry, body plethysmography, measurement of diffusion capacity, and blood gas analysis, were performed according to international standards [18][19][20].…”

Summarizing empirical information on between‐study heterogeneity for Bayesian random‐effects meta‐analysis

“…Report N14-04 44(fig.32, p. 233) reports on a meta-analysis involving two studies, and comparing endobronchial coil vs. no therapy for lung volume reduction in severe pulmonary emphysema. [45][46][47] The endpoint considered here is the log-OR of overall mortality at 12 months. The relevant data are illustrated in Figure 3.…”

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

“…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).…”