Lung volume reduction with endobronchial coils for patients with emphysema

Abstract

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.

Endobronchial coils for emphysema: Dual mechanism of action on lobar residual volume reduction

“…Endobronchial coils have been designed to treat this specific pathophysiological challenge by compressing lung parenchyma, which in turn creates tissue tension and restores radial support, thereby tethering airways open to reduce airway collapse and air trapping. 2,14,15 This is independent of collateral ventilation. While the design intent of the coils is well documented, the structural changes resulting from coil treatment have not previously been quantified.…”

“…1 However, bronchoscopic lung volume reduction using shape-memory nitinol endobronchial coils is a non-blocking technology, in that it allows ventilation of the treated lobe. 2 Mechanistically, endobronchial coils are presumed to be different from either traditional LVRS or endobronchial valves, although further investigation is needed to fully elucidate the mechanism of action of coils. Currently, only small studies have been performed to investigate the coil mechanism of action.…”

Impacts of Coil Treatment on Anxiety and Depression in Emphysema

“…Even though the decrease in the anxiety scale scores during evaluations before and after the procedure was not reflected in the statistics, a statistically significant decrease was observed in depression scores. e positive impact of the coil procedure on the lungs is shrinking the damaged emphysematous airways, thus reducing the lung volume leading to reduced hyperinflation and hence decreased dyspnea, decreased fast and surface respiration, reduction in airway resistance, and provision of air flow in healthy areas [26,27]. A decrease in both anxiety and depressive symptoms can be expected when the impacts of the procedure are considered on dyspnea and related factors thought to be factors of COPD and mental comorbidity.…”

Bronchoscopic Lung Volume Reduction Using Coil Therapy: Complications and Management

“…Before the procedure, patients must have quit smoking, received pulmonary physiotherapy for at least 6 months, and be under optimal medical treatment. Pre-procedure arterial oxygen partial pressure and carbon dioxide partial pressure must be > 50 mm Hg and < 55 mm Hg, respectively [9,10]. It is essential to evaluate right ventricular function using transthoracic echocardiography prior to the BLVR procedure.…”

“…In addition, acute inflammatory response to the procedure, and "coil-associated pneumonitis" have also been reported. Hence, many clinicians start corticosteroid (prednisolone 30 mg) and antibiotic (azithromycin 250 mg) prophylaxis in the preoperative period (1 day before) [10]. Corticosteroid treatment for 5 days and antibiotic therapy for 30 days after the procedure is recommended [10].…”