Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Kontogianni, Konstantina; Gerovasili, Vasiliki; Gompelmann, Daniela; Schuhmann, Maren; Herth, Felix; Eberhardt, Ralf

doi:10.1159/000358441

Cited by 47 publications

(37 citation statements)

References 29 publications

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“…For these CV+ patients, endoscopic coil therapy, polymeric lung volume reduction, and BTVA are examined [10,20,21]. Endoscopic coil therapy improves exercise capacity in patients with severe lung hyperinflation but of uncertain clinical importance [14].…”

Section: Discussionmentioning

confidence: 99%

Lung Volume Reduction with Vapor Ablation in the Presence of Incomplete Fissures: 12-Month Results from the STEP-UP Randomized Controlled Study

et al. 2016

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Background: Emphysema patients with collateral ventilation (CV) will not benefit from valve therapy, the most common endoscopic lung volume reduction procedure. A recent randomized controlled trial (STEP-UP) of the alternative bronchoscopic thermal vapor ablation (BTVA) included patients with (CV+) and without interlobar CV (CV-). Objectives: This analysis evaluated the efficacy and safety of the CV+ population following BTVA. Method: A post hoc fissure analysis of the baseline computed tomography of all treatment and control patients was performed with the VIDA Diagnostics Apollo software. A patient was considered to be CV+ if either of the treated upper lobes was adjacent to a fissure that was <90% complete. The primary endpoints, forced expiratory volume in 1 s (FEV₁) and St. George's Respiratory Questionnaire (SGRQ-C), were calculated for these CV+ patients following BTVA and safety results summarized. Results: 78% (35/45) of the patients in the treatment arm and 79% (19/24) of the patients in the control arm were found to be CV+. At 12 months, the FEV₁ improvement of the treatment arm was 9.2%, as compared with a decrease of 5.4% in the control group, resulting in a mean between-group difference of 14.6% (p = 0.0137). The improvement in SGRQ-C of the treatment arm as compared to the control arm was 8.4 points (p = 0.0712). An increase in respiratory related serious adverse events was observed immediately following treatment, but most resolved with routine care. Conclusion: BTVA can achieve safe and clinically meaningful improvement in pulmonary function and quality of life in patients with CV. These randomized controlled trial subgroup results offer proof of a viable solution for CV+ patients.

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Section: Discussionmentioning

confidence: 99%

Lung Volume Reduction with Vapor Ablation in the Presence of Incomplete Fissures: 12-Month Results from the STEP-UP Randomized Controlled Study

et al. 2016

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“…Patients in our series did not have chronic hypoventilation, which when present should be the main objective of management, even in the presence of severe PH [32,33]. None of the patients had endoscopic lung volume reduction, which may improve hemodynamic parameters in patients with severe emphysema and PH [34]. …”

Section: Discussionmentioning

confidence: 99%

Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

Girard¹,

Jouneau²,

Chabanne³

et al. 2015

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Background: There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). Objective: To evaluate the effect of PH-specific therapy in patients with COPD. Methods: All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. Results: Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m^-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. Conclusions: Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.

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“…Only one randomized, controlled trial (with crossover) has been published so far, which started in January 2010 [Shah et al 2013;Zoumot et al 2015]. In 2011, two uncontrolled studies started specifically focusing on patients with homogeneous emphysema [Klooster et al 2014a] and patients with incomplete fissures [Kontogianni et al 2014].…”

Section: Feasibility Safety and Efficacy Of Lvr Coil Treatmentmentioning

confidence: 99%

Treatment of emphysema using bronchoscopic lung volume reduction coil technology: an update on efficacy and safety

Hartman

Klooster

Hacken

et al. 2015

Ther Adv Respir Dis

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Abstract:In the last decade several promising bronchoscopic lung volume reduction (BLVR) treatments were developed and investigated. One of these treatments is BLVR treatment with coils. The advantage of this specific treatment is that it works independently of collateral flow, and also shows promise for patients with a more homogeneous emphysema disease distribution. Seven years ago, the very first patients were treated with BLVR coil treatment and currently large randomized, controlled trials are underway. The aim of this article is to review the available literature and provide an update on the current knowledge on the efficacy and safety of BLVR treatment with coils.

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Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Cited by 47 publications

References 29 publications

Lung Volume Reduction with Vapor Ablation in the Presence of Incomplete Fissures: 12-Month Results from the STEP-UP Randomized Controlled Study

Lung Volume Reduction with Vapor Ablation in the Presence of Incomplete Fissures: 12-Month Results from the STEP-UP Randomized Controlled Study

Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

Treatment of emphysema using bronchoscopic lung volume reduction coil technology: an update on efficacy and safety

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