Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema

Abstract

Background: Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients Methods: PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers. Results: Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George’s respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients’. Collateral ventilation was negative/fissure was intact (CV−/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes. Conclusion: In conclusion, EBV has favorable effects on patients’ outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.

Recent advances in bronchoscopic lung volume reduction for severe COPD patients

“…In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al .’s 2▪ systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care 1,3 .…”

“…Additionally, hyperinflation itself is an independent risk factor for mortality in patients with COPD 6 . Targeting the treatable trait of hyperinflation with EBV has already been proven effective in improving pulmonary function, exercise capacity and quality of life in the short term 2▪ ; however, what the effects are on dynamic hyperinflation and if patients not meeting the strict selection criteria can also be responders has only recently been reported.…”

“…The initial landmark trials demonstrating the positive effects of BLVR on quality of life, pulmonary function and exercise improvements had only limited follow-up to a maximum of 12 months 2▪ . Since then, this intervention gradually became standard clinical care in specialized intervention centres, resulting in the publication of real-life outcomes with longer follow-ups.…”

Bronchoscopic lung volume reduction in emphysema: a review

“…SGRQ changed by −7.44 points, MD in RV was 533 ml, and 6MWD improved by 37 m in patients with valves. Adverse events were noted to be higher in the short term for patients who received valves and included pneumothorax [odds ratio (OR):10.50], pneumonia (OR: 3.12), AECOPD (OR: 1.48) and hemoptysis (OR: 2.30) [39].…”

Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema: Erratum

“…In the July 2022 issue of Journal of Bronchology & Interventional Pulmonology in the article by Patel et al, “Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema,” there was an error in the first paragraph of the “Search Strategy” section on page 227. The search was not limited to the English language, as described in the paragraph 1…”