Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy

Abstract

Endobronchial valve (EBV) therapy may be associated with improvements in chronic obstructive pulmonary disease-related outcomes and may therefore be linked to improvements in the body mass index, airflow obstruction, dyspnoea, exercise capacity (BODE) index.Data from 416 patients with advanced emphysema and hyperinflation across Europe and USA, who were randomised to EBV (n5284) or conservative therapy (n5132) were analysed. Quantitative image analysis was used to compare the volume of the targeted lobe at baseline and at 6 months to determine target lobe volume reduction (TLVR).44% of patients receiving EBV therapy (versus 24.7% of controls) had clinically significant improvements in the BODE index (p,0.001). BODE index was significantly reduced by mean¡SD 1.4¡1.8, 0.2¡1.3 and 0.1¡1.3 points in patients with TLVR .50%, 20%-50% and ,20%, respectively (intergroup differences p,0.001), but increased by 0.3¡1.2 points in controls. Changes in BODE were predicted by baseline BODE and correlated significantly with lobar exclusion and lung volumes at 6 months.A greater proportion of patients in the treatment group than in the control group achieved a clinically meaningful improvement in BODE index; however, the likelihood of benefit was less than half in both groups. Patients in whom TLVR was obtained had greater improvements in clinical outcomes. Clinical trial: This study is registered at clinicaltrials.gov with identifier number NCT00129584.

Heterogeneity of Specific Gas Volume Changes

“…10 Endobronchial treatments are still in investigational phases; preliminary results are varied and may suff er from the lack of a precise imaging biomarker. Recently, it has been shown that quantitative CT scan target volume 11 and regional perfusion 12 analysis may help to identify lobar exclusion and to select the most responsive patients to endobronchial valve treatment. Measurements of changes in specifi c gas volume (SVg) via CT scan may not only be an excellent biomarker but may also provide specific regional information that can aid in surgical planning and evaluation posttreatment.…”

Endoscopic lung volume reduction in chronic obstructive airway disease using one-way valves

“…Therefore, real volume reduction seems to be also an important point for a better outcome. Complication rates such as COPD exacerbations were the same in all groups [18].…”

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

“…A retrospective study of the VENT results indicated that there was a significant correlation between TLVR and the success of EBV implantation (20). Improvements in the BODE index (more than 1 point) were observed in 67% of patients with a TLVR > 50%, 37% of patients with a TLVR of 20-50%, and 41% of patients with a TLVR < 20% (p = 0.011 for intergroup differences).…”