Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report

Abstract

PurposeEndobronchial valve (EBV) therapy is increasingly being seen as a therapeutic option for advanced emphysema, but its clinical utility in Asian populations, who may have different phenotypes to other ethnic populations, has not been assessed.Patients and methodsThis prospective open-label single-arm clinical trial examined the clinical efficacy and the safety of EBV in 43 consecutive patients (mean age 68.4±7.5, forced expiratory volume in 1 second [FEV1] 24.5%±10.7% predicted, residual volume 208.7%±47.9% predicted) with severe emphysema with complete fissure and no collateral ventilation in a tertiary referral hospital in Korea.ResultsCompared to baseline, the patients exhibited significant improvements 6 months after EBV therapy in terms of FEV1 (from 0.68±0.26 L to 0.92±0.40 L; P<0.001), 6-minute walk distance (from 233.5±114.8 m to 299.6±87.5 m; P=0.012), modified Medical Research Council dyspnea scale (from 3.7±0.6 to 2.4±1.2; P<0.001), and St George’s Respiratory Questionnaire (from 65.59±13.07 to 53.76±11.40; P=0.028). Nine patients (20.9%) had a tuberculosis scar, but these scars did not affect target lobe volume reduction or pneumothorax frequency. Thirteen patients had adverse events, ten (23.3%) developed pneumothorax, which included one death due to tension pneumothorax.ConclusionEBV therapy was as effective and safe in Korean patients as it has been shown to be in Western countries. (Trial registration: ClinicalTrials.gov: NCT01869205).

Lung perfusion and emphysema distribution affect the outcome of endobronchial valve therapy

“…Endoscopic lung volume reduction (ELVR) with valves has been shown to improve lung function, exercise capacity, and quality of life in selected patients with severe lung emphysema. 1 – 5 However, a large spectrum of clinical treatment responses has been observed, emphasizing the importance of patient selection prior to treatment. 1 Although the selection criteria for ELVR have recently improved, it remains a challenge for clinicians to identify those patients with the highest benefit–risk ratio.…”

Recurrent Chronic Obstructive Pulmonary Disease Exacerbations after Endobronchial Valve Implantation Are Associated with the Presence of <b><i>Pseudomonas aeruginosa</i></b>

“…However, some adverse events may limit the efficacy of this treatment option [4,5,9]. The main finding of our present study of patients with severe emphysema was the de novo presence of endobronchial Gram-negative bacteria after valve implantation that was associated with frequent COPD exacerbations requiring valve explantations.…”

“…Based on the existing studies, ELVR by means of endobronchial valve implantation may be an effective and safe therapy in patients with severe emphysema characterized by an absence of interlobar collateral ventilation [4,5,9]. However, some adverse events may limit the efficacy of this treatment option [4,5,9].…”

“…Endoscopic lung volume reduction (ELVR) by means of endobronchial valve implantation is an established therapy concept for selected patients with chronic obstructive pulmonary disease (COPD) and severe emphysema [1,2,3,4,5]. Endobronchial valve implantation results in improvement of clinical, lung function and hemodynamic parameters [6,7,8,9,10].…”

Clinical Utility of Quantitative CT Analysis for Fissure Completeness in Bronchoscopic Lung Volume Reduction: Comparison between CT and Chartis™

“…Bronchoscopic lung volume reduction (BLVR) was developed to treat hyperinflation in advanced emphysema (678). It can improve lung function and exercise capacity in selected patients (9101112), as well as ventilation perfusion mismatch (13). The Zephyr Endobronchial Valve (Pulmonx Inc., Redwood City, CA, USA) is the most extensively studied BLVR method.…”