Which Endoscopic Procedure to Use and in What Patient? Valves, Coils, Foam, and Heat in COPD and Asthma

Abstract

Despite the latest developments in therapeutic agents targeting airway endotypes, a significant proportion of patients with asthma and chronic obstructive pulmonary disease (COPD) remain symptomatic. Endoscopic therapies have a complementary role in the management of these airway diseases. The sustained efficacy of bronchial thermoplasty (BT) among patients with asthma over 10 years has been encouraging, as it has been shown to improve symptom control and reduce hospital admissions and exacerbations. Studies suggest that BT helps ameliorate airway inflammation and reduce airway smooth muscle thickness. While studies suggest that it is as effective as biologic agents, its role in the management of severe asthma has yet to be clearly defined and GINA 2022 still suggests limiting its use to patients with characteristics of the various populations studied.Conversely, bronchoscopic lung volume reduction has shown promise among patients with advanced COPD. Rigorous patient selection is important. Patients with minimal collateral ventilation (CV) and higher heterogeneity index have shown to benefit the most from endobronchial valve (EBV) therapy. For those with ongoing CV, endobronchial coils would be more appropriate. Both therapeutic modalities have demonstrated improved quality of life, effort tolerance, and lung function indices among appropriately selected patients. The emerging evidence suggests that endoscopic procedures among airway disease still have a substantial role to play despite the development of new therapeutic options.

Resolving persistent air leaks associated with autosomal dominant hyper-IgE syndrome using one-way endobronchial valves: report of cases

“…Since then, EBV have been used with great success in patients with complicated PAL. Although, unlike the multiple patient trials that have defined the clinical scenarios for successful deployment of EBV in COPD ( 5 , 6 ), PAL physiology is different and not yet rigorously studied in EBV trials ( 6 ).…”

Developing Interventions for Chronic Obstructive Pulmonary Disease

“…Endobronchial coils are available for use in some countries for the treatment of COPD in patients with collateral ventilation. [53][54][55] These nitinol coils (PneumRx Mountain View, CA) are placed in target airways via bronchoscopy. 48,56 A catheter deploys these devices as a wire, and then the coil reforms once at body temperature, resulting in compression of the diseased lung parenchyma with improved elastic recoil and decreased dynamic hyperinflation.…”

“…48,56 A catheter deploys these devices as a wire, and then the coil reforms once at body temperature, resulting in compression of the diseased lung parenchyma with improved elastic recoil and decreased dynamic hyperinflation. [53][54][55]57 These devices have had mixed clinical results and are undergoing further refinements with the most recent being the lung volume reverser system. 53,54,58,59 There have been a few randomized clinical trials evaluating the use of the coils in emphysema: RESET (endobronchial coils for the treatment of severe emphysema with hyperinflation), RENEW (lung volume reduction coil treatment in patients with emphysema), and REVOLENS (reduction de volume par voie endobronchique par spirales).…”