Bronchoscopic lung volume reduction procedures for chronic obstructive pulmonary disease

Agteren, Joseph EM van; Hnin, Khin; Carson, Kristin; Grosser, Dion; Smith, Brian J.

doi:10.1002/14651858.cd012158

Cited by 8 publications

(11 citation statements)

References 70 publications

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“…Lung volume reduction by either surgery or bronchoscopically placed valves is an option for highly selected patients with severe emphysema, hyperinflation and ongoing symptoms despite maximal medical management and pulmonary rehabilitation. Surgery is associated with increased short term mortality but reduced long term mortality, 29 while endobronchial techniques are associated with high short term morbidity (especially pneumothorax) but improved health outcomes at 12 months 30 . Such therapies should only be considered in specialised centres 31 …”

Section: Recommendationsmentioning

confidence: 99%

COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

Yang

Brown

George

et al. 2017

Medical Journal of Australia

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211

356

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Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.Non-pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.

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Section: Recommendationsmentioning

confidence: 99%

COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

Yang

Brown

George

et al. 2017

Medical Journal of Australia

Self Cite

211

356

View full text Add to dashboard Cite

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“…There is good evidence to support endobronchial lung volume reduction with the use of endobronchial valves in highly selected patients with cigarette smoking‐related emphysema. A 2017 Cochrane review noted short‐term (up to 1 year) improvements in lung function and disease status with high rates of adverse events especially pneumothorax . It is important to note that patients with AATD were excluded from these trials.…”

Section: Lvrs and Lung Transplantationmentioning

confidence: 99%

Diagnosis and treatment of lung disease associated with alpha one‐antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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AATD is a common inherited disorder associated with an increased risk of developing pulmonary emphysema and liver disease. Many people with AATD‐associated pulmonary emphysema remain undiagnosed and therefore without access to care and counselling specific to the disease. AAT augmentation therapy is available and consists of i.v. infusions of exogenous AAT protein harvested from pooled blood products. Its clinical efficacy has been the subject of some debate and the use of AAT augmentation therapy was recently permitted by regulators in Australia and New Zealand, although treatment is not presently subsidized by the government in either country. The purpose of this position statement is to review the evidence for diagnosis and treatment of AATD‐related lung disease with reference to the Australian and New Zealand population. The clinical efficacy and adverse events of AAT augmentation therapy were evaluated by a systematic review, and the GRADE process was employed to move from evidence to recommendation. Other sections address the wide range of issues to be considered in the care of the individual with AATD‐related lung disease: when and how to test for AATD, changing diagnostic techniques, monitoring of progression, disease in heterozygous AATD and pharmacological and non‐pharmacological therapy including surgical options for severe disease. Consideration is also given to broader issues in AATD that respiratory healthcare staff may encounter: genetic counselling, patient support groups, monitoring for liver disease and the need to establish national registries for people with AATD in Australia and New Zealand.

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“…In the past decade there has been a significant development in bronchoscopic treatments for emphysema. Multiple randomised controlled trials have been performed to evaluate bronchoscopic treatments such as coils, valves, vapour ablation, airway bypass stents and AeriSeal [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. These efforts have led to the inclusion of both coils and endobronchial valves in the 2017 Global Initiative for Chronic Obstructive Lung Disease therapeutic guidelines and the vapour ablation therapy in the 2019 guidelines [15,16].…”

Section: Introductionmentioning

confidence: 99%

New bronchoscopic treatment modalities for patients with chronic bronchitis

et al. 2021

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Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.

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Bronchoscopic lung volume reduction procedures for chronic obstructive pulmonary disease

Cited by 8 publications

References 70 publications

COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

Diagnosis and treatment of lung disease associated with alpha one‐antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand*

New bronchoscopic treatment modalities for patients with chronic bronchitis

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