Atelectasis and survival after bronchoscopic lung volume reduction for COPD

Hopkinson, Nicholas S; Kemp, Samuel V.; Tp, Toma; Hansell, D.M.; Geddes, D M; Shah, Pallav L.; Polkey, MI

doi:10.1183/09031936.00100110

Cited by 126 publications

(98 citation statements)

References 34 publications

(44 reference statements)

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“…Thus, the magnitude of improvement in BODE index in patients with .50% lung volume reduction is in a range suggestive of potential benefits such as a reduction in mortality. This hypothesis is further supported by two recent studies that were able to demonstrate long-term survival benefits in the presence of significant lung volume reduction [7,28].…”

Section: Discussionsupporting

confidence: 68%

“…Reports of EBV therapy in selected patients with end-stage emphysema have shown significant improvements in lung function and exercise tolerance [3][4][5][6]. The most significant functional and subjective improvements are seen when atelectasis develops after the insertion of valves [7,8]; however, EBV therapy may also be beneficial in the absence of atelectasis [9].…”

Section: Introductionmentioning

confidence: 99%

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

Valipour

Herth²,

Burghuber

et al. 2013

European Respiratory Journal

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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.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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

Valipour

Herth²,

Burghuber

et al. 2013

European Respiratory Journal

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“…The study also indicated that a TLVR of more than 350 mL was an independent predictor of the success of EBV implantation. A long-term-survival study (n = 19) indicated that 5 patients who developed atelectasis in the target lobe survived 6 years after EBV implantation while 8 of 14 patients with no atelectasis died (21). Another study (n = 33) indicated that patients with atelectasis in the target lobe after EBV implantation had a better long-term survival (22).…”

Section: Tlvrmentioning

confidence: 99%

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

Wang

et al. 2016

BST

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“…23 Also, in the interim, a multicentre randomised study evaluated the success of endobronchial valves in the treatment of heterogenous emphysema. 24 Taken as a group, modest but significant improvements were seen in FEV 1 and the six-minute walk distance although this came at the cost of more exacerbations.…”

Section: Improving Lung Mechanicsmentioning

confidence: 99%

Attacking the disease spiral in chronic obstructive pulmonary disease: an update

Polkey

Moxham

2011

Clinical Medicine

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-In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO 2 ) production. Patients with advanced COPD are flow limited and cannot excrete the CO 2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.

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Atelectasis and survival after bronchoscopic lung volume reduction for COPD

Cited by 126 publications

References 34 publications

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

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

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

Attacking the disease spiral in chronic obstructive pulmonary disease: an update

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