Data derived from a single randomized clinical trial or large non-randomized studies Level of evidence C Consensus of opinion of the experts and/or small studies, retrospective studies, registries

Intravenous MSC administration is feasible and has a good short-term safety profile in patients with moderately severe IPF.

The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema.44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40-75 yrs, forced expiratory volume in 1 s (FEV1) 15-45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) o1.2. Changes in FEV1, St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA.At 6 months, mean¡SE FEV1 improved by 141¡26 mL (p,0.001) and residual volume was reduced by 406¡113 mL (p,0.0001). SGRQ total score improved by 14.0¡2.4 points (p,0.001), with 73% improving by o4 points. Improvements were observed in 6MWD (46.5¡10.6 m) and mMRC dyspnoea score (0.9¡0.2) (p,0.001 for both). Lower respiratory events (n511) were the most common adverse event and occurred most often during the initial 30 days.BTVA therapy results in clinically relevant improvements in lung function, quality of life and exercise tolerance in upper lobe predominant emphysema.

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