Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema

Hatipoğlu, Umur; LaPrad, Adam S.; Schmid-Bindert, Gerald; Herth, Felix J.F.; Gompelmann, Daniela; Schuhmann, Maren; Eberhardt, Ralf; Harzheim, Dominik; Rump, B.; Slebos, Dirk‐Jan; Hacken, Nick ten; Klooster, Karin; Hartman, Jorine E.; Augustijn, Sonja W.S.; Shah, Pallav L.; Caneja, Cielito; McNulty, William; Garner, Justin; Deslée, G.; Vallerand, H.; Dury, Sandra; Gras, Delphine; Verdier, Margaux; Marquette, Charles‐Hugo; Sanfiorenzo, C.; Clary, Cathryn M.; Leheron, C.; Pradelli, J.; Korzeniewski, Steven J.; Wolter, P.; Arfi, T S; Macone, F.; Poudenx, M.; Leroy, Sylvie; Guillemart, A.; Griffonet, J.; Strange, Charlie; Argula, Rahul; Silvestri, Giuseppina; Huggins, John T.; Pastis, Nicholas J.; Woodford, D.; Schwarz, Lope Estévez; Walker, David; Criner, Gerard J.; Mamary, J.; Marchetti, Nathaniel; Desai, Parth; Shenoy, Kartik; Garfield, J.L.; Travaline, John M.; Criner, H.; Srivastava-Malhotra, S.; Tauch, V.; Maxfield, Roger A.; Brenner, Keith; Bulman, William A.; Whippo, Beth; Jellen, Patricia A.; Kalhan, Ravi; Gillespie, Colin T.; Rosenberg, Sharon R; DeCamp, Malcolm M.; Rogowski, A.S.; Hixon, J. E.; Angel, Luis F.; Dib, O.; Sciurba, Frank C.; Chandra, Divay; Crespo, Mateus; Field, J. Bon; Tedrow, John; Ledezma, Carlos J.; Consolaro, P.; Beckner, Marie E.; Majid, Adnan; Cheng, Guang‐Shing; Cárdenas-García, José; Beach, Douglas; Folch, Erik; Agnew, A.; Hori, Wataru; Nathanson, Arthur; Wahidi, Momen M.; Shofer, Scott; Hartwig, Matthew G.; Mahmood, Khalid; Smathers, Emily C.; Tillis, William; Verma, Kamal; Taneja, Deepa; Peil, M.; Chittivelu, Subramanyam; Doloszycki, P.; Whitten, Patrick; Aulakh, Baldev Singh; Ikadios, O.; Michel, Jonathan; Crabb, John W.; McVay, Bryan; Scott, Andrew; Pautler, E.A.; Connolly, Timothy A.; Santacruz, Jose F.; Kopas, Lisa; Parham, Rhian; Solid, B.; Krimsky, William; Grégoire, Françoise; King, Sinéad; Mehta, Atul C.; Almeida, Fábio; Gildea, Thomas R.; Cicenia, Joseph; Machuzak, Michael; Sethi, Sonali; Meli, Yvonne; Baran, Janet; Rice, Robert D.; Faile, D.; Rai, Navdeep; Jensen, Kurt; Kahlstrom, Richard; Haroon, Aasiya; Ionita, Ramona N.; White, Fred; Watkins, David; Moore, B.; Soukiasian, Harmik J.; Merry, Heather E.; Mosenifar, Zab; Ghandehari, Sara; Balfe, David; Park, J.; Mardirosian, R.; Ferguson, J. Scott; Kanne, Jeffrey P.; Sonetti, David A.; Modi, D.; Regan, Meredith M.; Maloney, James D.; Hackbarth, Mary E.; Gilles, M.; Harris, Amanda; Maser, Andrea; Puchalski, Jonathan; Rochester, Carolyn L.; Possick, Jennifer D.; Johnson, Kara; Dabre, Z.; Kovitz, Kevin L.; Joo, Min J.; DeLisa, Joel A.; Krishna, Ganesh; Canfield, James; Marfatia, Aditya; Selley, E.; Villalan, S.V.; Utz, James P.; Midthun, David E.; Kern, Ryan; Edell, Eric S.; Boras, L.L.; Gay, Steven; Bauman, Kristy A.; Han, MeiLan K.; Sagana, R.L.; Nelson, K.; Meldrum, Catherine A.; Jantz, Michael A.; Mehta, Hiren J.; Eagan, C.; West, Joseph; Delage, Antoine; Martel, Simon; Leblanc, Pierre; Maltais, François; Lacasse, Yves; Lampron, Noël; Laberge, Francis; Milot, Julie; Picard, J.; Breton, Marie-Josée; Dransfield, Mark T.; Wells, James M.; Bhatt, Surya P.; Smith, Patrick J.; Seabron-Harris, E.N.; Hammond, Kim; Egidio, C.

doi:10.1016/j.chest.2019.02.012

Cited by 31 publications

(25 citation statements)

References 31 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As implanting coils in a lobe of lesser ipsilateral destruction may result in a differing mechanism of action, these patients were excluded from this mechanistic analysis. 8,9 The RENEW trial was approved by all the 31 trial sites' medical ethical review committees, and all patients provided written informed consent.…”

Section: Patient Populationmentioning

confidence: 99%

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background and objective: The RENEW trial demonstrated that bronchoscopic lung volume reduction using endobronchial coils improves quality of life, pulmonary function and exercise performance. In this post hoc analysis of RENEW, we examine the mechanism of action of endobronchial coils that drives improvement in clinical outcomes. Methods: A total of 78 patients from the RENEW coiltreated group who were treated in one or both lobes that were deemed as the most destroyed were included in this retrospective analysis. Expiratory and inspiratory HRCT scans were used to assess lobar volume change from baseline to 12 months post coil treatment in treated and untreated lobes. Results: Reduction in lobar RV in treated lobes was significantly associated with favourable clinical improvement. Independent predictor of the change in RV and FEV 1 was the change in lobar RV reduction in the treated lobes and for change in 6MWD the absence of cardiac disease and the change in SGRQ, while the independent predictor of change in SGRQ was the change in 6MWD. Conclusion: Our results suggest that residual lobar volume reduction in treated lobes measured by QCT is the driving mechanism of action of endobronchial coils leading to positive clinical outcomes. However, the improvement in exercise capacity and quality of life seems to be affected by the presence of cardiac disease.

show abstract

Section: Patient Populationmentioning

confidence: 99%

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, for the EBV treatment, the absence of interlobar collateral ventilation is necessary to achieve successful outcomes and for the LVRC treatment superior outcomes are observed in patients with very severe static hyperinflation and absence of significant airway disease. [3][4][5][6][7] Several questions on patient selection for BLVR remain unanswered. For example, it is unknown what proportion of patients referred for BLVR is potentially eligible for any form of BLVR treatment and to our knowledge, this group of patients has not been well characterized in the literature.…”

Section: Introductionmentioning

confidence: 99%

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

Welling¹,

Hartman²,

Augustijn³

et al. 2020

COPD

Self Cite

View full text Add to dashboard Cite

Purpose: Bronchoscopic lung volume reduction (BLVR) is a valuable treatment option for carefully selected patients with severe COPD. There is limited knowledge about the characteristics and outcomes of patients referred to a specialized center for BLVR. The study objectives were to investigate the selection rate for BLVR treatment in patients referred for this treatment and to investigate the differences between patients that were selected for BLVR and patients that were not. Patients and Methods: We performed a retrospective analysis of patients with severe COPD who were referred to our hospital to assess eligibility for BLVR treatment. Our parameters included demographics, comorbidity, chest computed tomography characteristics, reasons for rejection from BLVR treatment and patient survival. Results: In total, 1500 patients were included (mean age 62 years, 50% female and forced expiratory volume in 1 s 33% of predicted). Out of this group, 282 (19%) patients were selected for BLVR treatment. The absence of a suitable target lobe for treatment, an unsuitable disease phenotype and insufficient lung hyperinflation were the most important factors for not being selected. Patients that were selected for any BLVR option lived significantly longer than the group of patients that were not selected for BLVR (median 3060 versus 2079 days, P<0.001). Conclusion: We found that only a small proportion of patients that are referred for BLVR treatment is eligible for a BLVR treatment, indicating a need for both better referral tools and for the development of new therapies for this group of patients. Furthermore, our data suggest that selection for BLVR is associated with a significant survival benefit.

show abstract

“…Since both providers required CT slice thicknesses be no more than 1 mm, only 16 out of 29 CTs could be included in the analysis. When target lung lobes were determined by computed algorithms, the selected lobes differed from clinician's choice in 18.75% and 30% of cases, respectively. We therefore checked for any correlation between not-responding to ELVR in any category and software-clinician-mismatch.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic lung volume reduction coils for patients with severe emphysema – a single-center retrospective analysis

Mang

Hus

Schäfers

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundPatients with chronic obstructive pulmonary disease (COPD) and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol-coil-based endoscopic lung volume reduction techniques have been ambiguous.Objectives The analysis was done to analyze outcomes of ELVR with nitinol-coils in patients with severe pulmonary emphysema.MethodsFrom September 2013 to November 2014, our center performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anesthesia. 12 out of 29 patients received contralateral treatments 4-6 weeks later to avoid bilateral pneumothorax. Lung function and 6-minute walking distance were assessed one week prior, one week after as well as 6 to 12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.ResultsWhile coil-based ELVR led to significant short-term improvement of vital capacity (VC, + 0.14 l ± 0.39 l, p = 0.032) and hyperinflation (ΔRV / TLC -2.32% ± 6.24%, p = 0.022), no significant changes were observed in 6-minute walking distance (6-MWD) or forced expiratory volume in one second (FEV1). Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in FEV1 or residual volume (RV) after 6 months. Adverse events included hemoptysis (40 %) and pneumothorax (3.4 %), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.ConclusionEndoscopic lung volume reduction coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.

show abstract

Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema

Cited by 31 publications

References 31 publications

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

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

<p>Patient Selection for Bronchoscopic Lung Volume Reduction</p>

Endoscopic lung volume reduction coils for patients with severe emphysema – a single-center retrospective analysis

Contact Info

Product

Resources

About