Inhaled Steroids, Sex and Emphysema Index – Clinical Parameters with Impact on the Effectiveness of Valve Implantation in Patients with Severe Emphysema

Polke, Markus; Brugger, Jonas; Rötting, Matthias; Polke, Nilab; Brock, Judith; Schuler, Stefanie; Richter, Ines; Eberhardt, Ralf; Herth, Felix; Gompelmann, Daniela

doi:10.2147/copd.s361256

Cited by 3 publications

(1 citation statement)

References 16 publications

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“… 22 Furthermore, ICS use and higher emphysema index were shown as predictors for inferior outcome. 23 No analysis regarding the outcome specific for patients with valve replacements has been done so far.…”

Section: Discussionmentioning

confidence: 99%

Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung Volume Reduction

Brock¹,

Schuster²,

Böhmker³

et al. 2023

COPD

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Purpose Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit. Patients and Methods We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified. Results We identified 73 patients with 1–12 revision bronchoscopies and 1–5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before. Conclusion Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.

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Section: Discussionmentioning

confidence: 99%