Bronchoscopic lung volume reduction: indications, effects and prospects

Hopkinson, Nicholas S

doi:10.1097/mcp.0b013e328012e053

Cited by 26 publications

(18 citation statements)

References 33 publications

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“…However, practice has shown that a clinically significant volume reduction is not always achieved, with atelectasis obtained in about 50% of cases [12,13,14,15]. Observations suggest that the lack of volume reduction is due to collateral ventilation [16,17], a phenomenon with major implications for patient selection and EBV treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

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Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study

Oliveira

Oliveira²,

Rambo³

et al. 2016

Respiration

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Background: One-way endobronchial valves (EBVs) relieve symptoms of emphysema, particularly in patients without collateral ventilation between the target and adjacent lobes. Pretreatment knowledge of fissure integrity could serve as an aid in indicating EBV interventions. Objective: This study aimed to investigate the relationship between software-measured lung fissure integrity and clinically relevant lung volume reduction (≥350 ml) in emphysema patients treated with one-way EBVs using a lobar exclusion strategy. Methods: Of 108 patients treated between March 2008 and July 2014, 38 had both baseline and follow-up computed tomography (CT) scans acquired following a specific protocol for quantitative CT analysis and were included in the study (total of 39 treatments, two lungs treated in 1 patient). Outcome measures were fissure integrity measured on baseline CT scans, difference between pre- and postoperative lung volume (considering the lowest measured postoperative volume), and correlation between fissure integrity and volume change. Results: Fissure integrity ≥75% correlated with volume reduction ≥350 ml (Spearman coefficient: -0.65; p < 0.01). The mean and median volume reductions were 1,223.96 ± 907.5 ml and 663 ml, respectively, for lungs with fissure integrity ≥75% (n = 31). The accuracy of fissure integrity ≥75% in predicting a volume reduction was 87.2%. The positive predictive value of fissure integrity ≥75% to predict a volume reduction ≥350 ml was 83.9%, and it was 70% for fissure integrity 75-90% and 90.5% for fissure integrity >90%. Conclusions: A target lobe volume reduction using EBVs is possible with lung fissure integrity ≥75%. For patients with fissure integrity between 75 and 90%, a further evaluation of interlobar ventilation should be performed. A clinically relevant volume reduction following treatment with EBVs is likely with any level of fissure integrity >90%.

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Section: Introductionmentioning

confidence: 99%

“…Collateral ventilation has been linked to interlobar fissure incompleteness [15,16,17,18,19]. The existence of intact, incomplete, or absent interlobar fissures [defined by visual inspection of computed tomography (CT) scans] [20] has been extensively described in the literature [21,22].…”

Section: Introductionmentioning

confidence: 99%

Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study

Oliveira

Oliveira²,

Rambo³

et al. 2016

Respiration

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“…Bronchoscopic approaches to achieve lung volume reduction have recently been explored as safer alternatives to lung volume reduction surgery (LVRS) for treating advanced emphysema [1,2]. While these techniques are associated with less morbidity and mortality than LVRS, the majority have demonstrated limited effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Advanced Emphysema with Emphysematous Lung Sealant (AeriSeal®)

et al. 2011

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Background: This report summarizes initial tests of an emphysematous lung synthetic polymer sealant (ELS) designed to reduce lung volume in patients with advanced emphysema. Objectives: The primary study objective was to define a therapeutic strategy to optimize treatment safety and effectiveness. Methods: ELS therapy was administered bronchoscopically to 25 patients with heterogeneous emphysema in an open-label, noncontrolled study at 6 centers in Germany. Treatment was performed initially at 2–4 subsegments. After 12 weeks, patients were eligible for repeat therapy to a total of 6 sites. Safety and efficacy were assessed after 6 months. Responses were evaluated in terms of changes from baseline in lung physiology, functional capacity, and health-related quality of life. Follow-up is available for 21 of 25 patients. Results: Treatment was well tolerated. There were no treatment-related deaths (i.e. within 90 days of treatment), and an acceptable short- and long-term safety profile. Physiological and clinical benefits were observed at 24 weeks. Efficacy responses were better among Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III patients [n = 14; change in residual volume/total lung capacity (ΔRV/TLC) = –7.4 ± 10.3%; Δ forced expiratory volume in 1 s (ΔFEV₁) = +15.9 ± 22.6%; change in forced vital capacity (ΔFVC) = +24.1 ± 22.7%; change in carbon monoxide lung diffusion capacity (ΔDLCO) = +19.3 ± 34.8%; change in 6-min walk test (Δ6MWD) = +28.7 ± 59.6 m; change in Medical Research Council Dyspnea (ΔMRCD) score = –1.0 ± 1.04 units; change in St. George’s Respiratory Questionnaire (ΔSGRQ) score = –9.9 ± 15.3 units] than for GOLD stage IV patients (n = 7; ΔRV/TLC = –0.5 ± 6.4%; ΔFEV₁ = +2.3 ± 12.3%; ΔFVC = +2.6 ± 21.1%; ΔDLCO = –2.8 ± 17.2%; Δ6MWD = +28.3 ± 58.4 m; ΔMRCD = 0.3 ± 0.81 units; ΔSGRQ = –6.7 ± 7.0 units). Conclusions: ELS therapy shows promise for treating patients with advanced heterogeneous emphysema. Additional studies to assess responses in a larger cohort with a longer follow-up are warranted.

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“…Controversy exists over the unilateral or bilateral surgery in one stage or multiple sessions. However, studies indicate that long-term effects of one-side LVRS are similar to that of both sides [7,8].…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Thoracoscopic Surgery for Treatment of Chronic Obstructive Pulmonary Disease

et al. 2015

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The aim of this study is to evaluate the safety and efficacy of lung volume reduction surgery (LVRS) by videoassisted thoracoscopic surgery (VATS) in the treatment of chronic obstructive pulmonary disease (COPD). A total of 90 patients with COPD from 2002 to 2012 were enrolled into our study, comprising 22 who underwent conventional thoracotomies and 68 VATS. Pulmonary function testings, arterial blood gases analysis, and quality of life between these two groups were compared. VATS was found to be superior to the conventional thoracotomy in terms of length of hospital stay, intraoperative blood loss, intubation time, volume of chest tube drainage, and postoperative pain assessment (P<0.05). However, significant differences in pulmonary function testings, arterial blood gases analysis, 6-min walking distance (6-MWD), and postoperative quality of life between the two groups were not found (P>0.05). LVRS by VATS is a safe and reliable surgical approach for the treatment of COPD, with less invasiveness and shorter hospital recovery time.

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Bronchoscopic lung volume reduction: indications, effects and prospects

Cited by 26 publications

References 33 publications

Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study

Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study

Treatment of Advanced Emphysema with Emphysematous Lung Sealant (AeriSeal®)

Video-Assisted Thoracoscopic Surgery for Treatment of Chronic Obstructive Pulmonary Disease

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