Background Since successful development of endobronchial valves (EBV) as treatment for severe emphysema, its main complication, pneumothorax, remains an important concern. Objective We hypothesized that a two-step EBV implantation, during two distinct iterative procedures could lead to a more progressive target lobe volume reduction (TLVR) and thus ipsilateral lobe re-expansion, resulting in a significant decrease in the pneumothorax rate. Methods This retrospective bi-center study carried out by Limoges and Toulouse University Hospitals included patients following the inclusion criteria established by the BLVR expert panel. All patients were treated by two distinct procedures: first, EBVs were placed in all but the most proximal segment or sub-segment. The remaining segment was treated subsequently. All patients had a complete evaluation before treatment, and 3 months after the second procedure. Results Out of 58 patients included, only 4 pneumothoraxes (7%) occurred during the study. The other complications were pneumonia and severe COPD exacerbation (8.6% and 13.7% of patients, respectively). Significant improvement was found for FEV 1 (+19.6 ± 25%), RV (−468 ± 960mL), 6MWD (30 ± 85m), BODE Index (−1.4 ± 1.8 point) and TLVR (50.6 ± 35.1%). Significant TLVR (MCID) was obtained in 74.1% of patients (43/58). Conclusion This new approach using EBV could reduce the incidence of pneumothorax without increasing other complication rates. Clinical and physiological outcomes are similar to those reported in studies using the conventional single-step treatment.
Background and Objective Dynamic hyperinflation (DH) is a major marker of exertional dyspnoea in severe emphysema. We hypothesized that bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs) decreases DH. Methods In this prospective bi‐centre study from both Toulouse and Limoges Hospitals, we assessed DH during an incremental cycle ergometry before and 3 months after EBVs treatment. The primary objective was to observe the change in inspiratory capacity (IC) at isotime. Target lobe volume reduction (TLVR) and changes in residual volume (RV), forced expiratory volume in one‐second (FEV1), mMRC, 6 minutes walking distance (6MWD), BODE and other dynamic measures like tele‐expiratory volume (EELV) were also analysed. Results Thirty‐nine patients were included, of whom thirty‐eight presented DH. IC and EELV at isotime significantly improved (+214 mL, p = 0.004; −713 mL, p ˂ 0.001, respectively). Mean changes were +177 mL for FEV1 (+19%, p < 0.001), −600 mL for RV (p < 0.0001), +33 m for 6MWD (p < 0.0001), respectively. Patients who responded on RV (>430 mL decrease) and FEV1 (>12% gain) had better improvements compared to non‐responders (+368 mL vs. +2 mL; +398 mL vs. −40 mL IC isotime, respectively). On the opposite, in patients who responded on DH (>200 mL IC isotime increase), changes in TLV (−1216 mL vs. −576 mL), FEV1 (+261 mL vs. +101 mL), FVC (+496 mL vs. +128 mL) and RV (−805 mL vs. −418 mL) were greater compared to non‐responders. Conclusions DH decreases after EBVs treatment, and this improvement is correlated with static changes.
Severe refractory asthma affects 3-5% of asthmatic patients, but represents 50-80% of asthma-related healthcare costs [1]. Although therapies targeting IgE and, more recently, IL5 and IL4/13 have recently gained approval for the treatment of severe refractory asthma in a subset of patients with type 2 phenotypes, there is still a need to cover a wider range of patients, in particular those with a non-type 2 phenotype or for whom biotherapies failed.Bronchial thermoplasty, a bronchoscopic approach that uses radiofrequency energy to target airway smooth muscle [2], has been recently approved for the management of severe refractory asthma based on the outcomes of three randomised trials [3][4][5]. This procedure improves symptom control and quality of life (QoL) [3, 5], and durably [6] decreases the rate of exacerbations and emergency visits [3][4][5].
Isolated right middle lobe (RML) lung volume reduction using endobronchial valves can lead to significant improvements in appropriately selected patients, with highly hyperinflated RML and preserved upper and lower lobes https://bit.ly/3rICgTn
Based on the positive results of five randomised controlled trials, bronchoscopic lung volume reduction (BLVR) using Zephyr endobronchial valves (EBV) implantation has been approved for the treatment of patients with severe emphysema and little to no collateral ventilation [1]. These one-way valves produce an atelectasis (or volume reduction) of the target lobe, which leads to decreased hyperinflation and ultimately improvement in exercise capacity. However, EBV therapy is associated with a number of potential adverse events, pneumothorax being the most frequent and threatening complication, occurring in ∼20% of cases [1], and whose treatment is based on chest tube insertion, suction and in cases of prolonged air leaks, valve(s) removal [2]. We report a very rare complication of EBV-induced pneumothorax treatment: a pneumatocoele. We propose a mechanistic explanation and preventive measures.
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