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Dumanli A, Metin B, Gunay E. Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey. Ann Saudi Med 2020; 40:469-476. [PMID: 33307740 PMCID: PMC7733646 DOI: 10.5144/0256-4947.2020.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/25/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES Compare our experience with valve and coil BLVR devices. DESIGN Retrospective. SETTING Single tertiary care centre. PATIENTS AND METHODS Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES Change in PFTs and completion of the 6MWT. SAMPLE SIZE 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ahmet Dumanli
- From the Department of Chest Surgery, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Bayram Metin
- From the Department of Chest Surgery, Acibadem Hospitals Group, Kayseri, Turkey
| | - Ersin Gunay
- From the Department of Pulmonology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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52
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Zantah M, Gangemi AJ, Criner GJ. Bronchoscopic lung volume reduction: status quo. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1469. [PMID: 33313214 PMCID: PMC7723581 DOI: 10.21037/atm-20-1551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Emphysema is associated with irreversible loss of lung compliance leading to gas trapping and hyperinflation. Surgical lung volume reduction has proven to improve lung function, exercise capacity, cardiac health and survival in patients with advanced emphysema; however, this procedure is associated with significant morbidity and mortality. Bronchoscopic lung volume reduction (BLVR) has emerged as an alternative approach for these patients. In this article, we review the different techniques used for the purpose of this procedure, its advantages and disadvantages. In addition, we discuss in length valve therapy and the studies that led to its recent FDA approval. Finally, we provide thought-provoking challenges that may be topics for further future investigation to enhance the efficacy and benefit of this technique.
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Affiliation(s)
- Massa Zantah
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Andrew J Gangemi
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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53
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Wang R, Paul S, Truong V, Munavvar M. Bronchoscopic interventions for emphysema: Current status. Lung India 2020; 37:518-529. [PMID: 33154215 PMCID: PMC7879872 DOI: 10.4103/lungindia.lungindia_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022] Open
Abstract
Chronic obstructive pulmonary disease is a prevalent and progressive disease. The recently developed bronchoscopic lung volume reduction (BLVR) techniques offer personalized therapeutic options in subgroups of patients with severe emphysema. Endobronchial and intrabronchial valves (EBV/IBV) achieve lung volume reduction by lobar atelectasis. The lung volume reduction coils (LVRCs) and bronchoscopic thermal vapor ablation (BTVA) induce tissue compression, either mechanically or through inflammatory processes. While the effects of EBV/IBV are reversible by removing the implants, the effects of LVRC are partially reversible and that of BTVA is irreversible. The presence of interlobar collateral ventilation (CV) impacts on EBV/IBV treatment outcome due to its mechanism of action. Therefore, using radiological and endoscopic techniques to assess CV has a vital importance. Current evidence of BLVR demonstrates acceptable safety and short-term clinical efficacy. However, head-to-head trials are lacking, and further research is needed to establish long-term clinical benefit, durability, and cost-effectiveness of these techniques.
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Affiliation(s)
- Ran Wang
- School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Suman Paul
- Department of Respiratory, Lancashire Teaching Hospital NHS Foundation Trust, Preston, United Kingdom
| | - Vi Truong
- School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Mohammed Munavvar
- School of Biological Sciences, The University of Manchester, Manchester; Department of Respiratory, Lancashire Teaching Hospital NHS Foundation Trust, Preston, United Kingdom
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54
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Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med 2020; 202:29-50. [PMID: 32023078 DOI: 10.1164/rccm.201907-1292so] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Fabien Maldonado
- Department of Medicine and Department of Thoracic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Neal Patel
- Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Pallav L Shah
- Respiratory Medicine at the Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Vienna, Austria; and
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark Weir
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Felix J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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55
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Zarogoulidis P, Hohenforst-Schmidt W, Huang H, Sapalidis K, Kosmidis C, Tryfon S, Vagionas A, Tsakiridis K, Drevelegas K, Romanidis K, Freitag L. Vapor for lung volume reduction; pros and cons. Expert Rev Respir Med 2020; 14:1189-1195. [PMID: 32870725 DOI: 10.1080/17476348.2020.1816467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bronchoscopic lung volume reduction (BLVR) is a novel approach for treatment of emphysema. Several techniques are available to accomplish BLVR including Bronchoscopic Vapor Thermal Ablation (BVTA). This technique is easy to perform and considered safe due to its gradual effect. We discuss BTVA in detail in this editorial. AREAS COVERED We discuss our experience with BTVA in detail including patient selection, equipment, procedure, post-procedural care and complications. We also review the literature to determine the pros and cons for its use. Other modalities such as endobronchial valves, coils and lung sealants are also briefly discussed. EXPERT OPINION Vapor ablation is a novel and safe approach in inducing lung volume reduction in emphysema patients. The effects are gradual, and therefore potentially making it safer than other minimally invasive modalities. Pneumonitis and infection are common side effects. Just as in other BLVR techniques, a case by case evaluation is needed to determine the right candidate for BTVA. Further larger studies are needed before BTVA becomes standard of care in treatment of patients with emphysema.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, ``Bioclinic`` Private Hospital , Thessaloniki, Greece.,3rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School , Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen , Hof, Germany
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University , Shanghai, P. R. China
| | | | | | - Stavros Tryfon
- Pulmonary Department, (NHS), ``G. Papanikolaou`` General Hospital , Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- Thoracic Surgery Department, ``Interbalkan`` European Medical Center , Thessaloniki, Greece
| | | | - Konstantinos Romanidis
- Second Department of Surgery, General University Hospital of Alexandroupolis, Medical School Democritus University of Thrace , Alexandroupolis, Greece
| | - Lutz Freitag
- Department of Pulmonology, University Hospital Zurich Rämistrasse 100, 8091 , Zurich, Switzerland
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56
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Easter M, Bollenbecker S, Barnes JW, Krick S. Targeting Aging Pathways in Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2020; 21:E6924. [PMID: 32967225 PMCID: PMC7555616 DOI: 10.3390/ijms21186924] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has become a global epidemic and is the third leading cause of death worldwide. COPD is characterized by chronic airway inflammation, loss of alveolar-capillary units, and progressive decline in lung function. Major risk factors for COPD are cigarette smoking and aging. COPD-associated pathomechanisms include multiple aging pathways such as telomere attrition, epigenetic alterations, altered nutrient sensing, mitochondrial dysfunction, cell senescence, stem cell exhaustion and chronic inflammation. In this review, we will highlight the current literature that focuses on the role of age and aging-associated signaling pathways as well as their impact on current treatment strategies in the pathogenesis of COPD. Furthermore, we will discuss established and experimental COPD treatments including senolytic and anti-aging therapies and their potential use as novel treatment strategies in COPD.
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Affiliation(s)
- Molly Easter
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
| | - Seth Bollenbecker
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
| | - Jarrod W. Barnes
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
- Gregory Fleming James Cystic Fibrosis Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; (M.E.); (S.B.); (J.W.B.)
- Gregory Fleming James Cystic Fibrosis Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
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57
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van Dijk M, Gan CT, Koster TD, Wijkstra PJ, Slebos DJ, Kerstjens HAM, van der Vaart H, Duiverman ML. Treatment of severe stable COPD: the multidimensional approach of treatable traits. ERJ Open Res 2020; 6:00322-2019. [PMID: 32984420 PMCID: PMC7502698 DOI: 10.1183/23120541.00322-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/26/2020] [Indexed: 01/02/2023] Open
Abstract
Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of “there is nothing to improve” any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care. Severe COPD is not hopeless; in light of treatment options such as pulmonary rehabilitation, bronchoscopic lung volume reduction, chronic noninvasive ventilation and lung transplantation, every patient deserves a personalised assessment of treatable traitshttps://bit.ly/2TO7jxB
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Affiliation(s)
- Marlies van Dijk
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Christiaan T Gan
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - T David Koster
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Peter J Wijkstra
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Hester van der Vaart
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands.,Centre of Rehabilitation Beatrixoord, Haren, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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58
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Franke KJ, Domanski U, Schröder M, Nilius G. Effects of endobronchial coils for endoscopic lung volume reduction on sleep in COPD patients with advanced pulmonary emphysema. Sleep Breath 2020; 25:727-735. [PMID: 32845475 DOI: 10.1007/s11325-020-02176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Treatment of advanced pulmonary emphysema with endobronchial coils can improve clinical outcomes like quality of life (QOL). Yet, patients with chronic obstructive pulmonary disease (COPD) are also known to suffer from reduced sleep quality. The effect of coil therapy on sleep has not yet been investigated. The primary aim of this study was to investigate sleep efficiency before and after coil treatment. Secondly, we investigated the effects on nocturnal breathing pattern, QOL, and physical activity. METHODS Polysomnography (PSG) testing was performed before (T0), 6 month after (T3), and 12 months after (T4) treatment with endobronchial coils. Further examinations included QOL by St George's Respiratory Questionnaire (SGRQ) and COPD assessment test (CAT), and physical activity using an accelerometer for 1 week after each visit. RESULTS Of 21 patients, 14 completed the study: 6 women; mean age 58.0 ± 4.9 years; BMI 22.6 ± 4.6 kg/m2; FEV1 28.6 ± 7.1% predicted; residual volume (RV) 278.2 ± 49.4% predicted. Sleep efficiency did not vary between baseline and follow-up examinations (T0 69.0 ± 15.8%; T3 70.9 ± 16.0%; T4 66.8 ± 18.9%). Non-REM respiratory rate decreased compared to baseline (T0 19.4 ± 3.9/min; T3 17.8 ± 3.5/min; T4 17.1 ± 3.1/min (p = 0.041; p = 0.030) and QOL improved meeting the minimal clinically important difference (MCID) (SGRQ, T3 -12.8 units; T4 -7.1 units; CAT: T3 -5.6 units; T4 -3.4 units). No increase in physical activity was recorded (light activity T0 31.9 ± 9.9; T3 30.8 ± 16.9; T4 26.3 ± 10.6 h/week). CONCLUSIONS Treatment with endobronchial coils did not influence objectively measured sleep quality or physical activity, but reduced nocturnal breathing frequency and improved QOL in severe emphysema patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02399514, First Posted: March 26, 2015.
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Affiliation(s)
- Karl-Josef Franke
- Märkische Kliniken GmbH, Klinikum Lüdenscheid, Lüdenscheid, Germany.,Witten-Herdecke University, Witten, Germany
| | | | | | - Georg Nilius
- Kliniken Essen-Mitte, Essen, Germany.,Witten-Herdecke University, Witten, Germany
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59
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Marchetti N, Duffy S, Criner GJ. Interventional Bronchoscopic Therapies for Chronic Obstructive Pulmonary Disease. Clin Chest Med 2020; 41:547-557. [PMID: 32800205 DOI: 10.1016/j.ccm.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with severe chronic obstructive pulmonary disease who fail maximal medical therapy have bronchoscopic options that can improve lung function, quality of life, and exercise performance. Those with upper lobe predominant emphysema can consider bronchoscopic lung volume reduction with endobronchial valves. Select patients with diffuse emphysema and severe hyperinflation can also be considered for endobronchial valves. Bronchoscopic techniques targeting cholinergic pathways and mucus hypersecretion are under development. Ultimately, patients with advanced chronic obstructive pulmonary disease who are not eligible for or have failed bronchoscopic interventions can consider lung volume reduction surgery or even lung transplantation, if free from major comorbidities.
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Affiliation(s)
- Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA.
| | - Sean Duffy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
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60
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Greer M, Welte T. Chronic Obstructive Pulmonary Disease and Lung Transplantation. Semin Respir Crit Care Med 2020; 41:862-873. [PMID: 32726838 DOI: 10.1055/s-0040-1714250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection-currently referred to as chronic lung allograft dysfunction-represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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61
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Kotecha S, Williams TJ. Endobronchial coils for emphysema: Do they work and why? Respirology 2020; 25:1116-1118. [PMID: 32657008 DOI: 10.1111/resp.13895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sakhee Kotecha
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Trevor J Williams
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
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62
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Wienker J, Karpf-Wissel R, Funke F, Taube C, Wälscher J, Winantea J, Maier S, Mardanzai K, Darwiche K. Predictive value of Chartis measurement for lung function improvements in bronchoscopic lung volume reduction. Ther Adv Respir Dis 2020; 14:1753466620932507. [PMID: 32615853 PMCID: PMC7339075 DOI: 10.1177/1753466620932507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Bronchoscopic lung volume reduction (BLVR) via valve
implantation can be achieved by targeting severely hyperinflated and
emphysematously destructed lung areas in patients with chronic obstructive
lung disease. Lack of collateral ventilation (CV) is important for good
outcomes with BLVR. CV can be measured using the catheter-based Chartis
system. The aim of this study was to evaluate the correlation between total
exhaled volume drained from the target lobe measured by Chartis and clinical
outcomes after BLVR in CV-negative patients. Methods: From January 2016 to March 2019, 60 patients were included in this
retrospective single-center analysis. Drained volume (TVol) measured by
Chartis was recorded and compared with lung function and physical
performance parameters. Outcome variables included the percentage change in
lung function [forced expiratory volume in 1 s (FEV1), residual
volume (RV), and inspiratory vital capacity (IVC)]. Secondary outcomes were
the degree of target lobe volume reduction (TLVR), change in 6-min walk
distance (6MWD), and change in chronic obstructive pulmonary disease (COPD)
assessment test (CAT) score. Results: Drained volume correlated significantly with post-BLVR change in
FEV1 (r = 0.663), IVC
(r = 0.611), RV (r = −0.368), and TLVR
(r = 0.635) (all p < 0.05). In
a priori-defined patient subgroups based on drained
volume [<100 ml (n = 19), 100−400 ml
(n = 33), and >400 ml (n = 8)]; mean
changes in FEV1 were 2.6%, 17.4%, and 51.3%; in RV were −3.9%,
−10.6%, and −23.8%; in IVC were −4.0%, 10.6%, and 62.4%; and in TLVR were
525 ml (39%), 1375 ml (73%) and 1760 ml (100%), respectively. There were no
significant correlations between absolute and percentage changes in 6MWD and
the CAT score. Lung volume reduction was diagnosed in 32 (53%) cases. Conclusion: Drained volume measured by the Chartis system correlated with functional
improvement in CV-negative patients undergoing BLVR. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Johannes Wienker
- Department of Pneumology, Division of Interventional Pneumology, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, Essen, NRW 45239, Germany
| | - Rüdiger Karpf-Wissel
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Faustina Funke
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Christian Taube
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Julia Wälscher
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Jane Winantea
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Sandra Maier
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Kaid Darwiche
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
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de Weger WW, Klooster K, Ten Hacken NH, van Dijk M, Hartman JE, Slebos DJ. Determining Static Hyperinflation in Patients with Severe Emphysema: Relation Between Lung Function Parameters and Patient-Related Outcomes. Lung 2020; 198:629-636. [PMID: 32596757 PMCID: PMC7374464 DOI: 10.1007/s00408-020-00368-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bronchoscopic lung volume reduction techniques are minor invasive treatment modalities for severely hyperinflated emphysema patients. The severity of static lung hyperinflation determines eligibility and success rate for these treatments. However, it is not exactly known what parameter should be used to optimally reflect hyperinflation. Commonly used parameters are residual volume (RV) and the RV/Total lung capacity (TLC) ratio. Other parameters reflecting hyperinflation are Inspiratory Capacity/TLC and forced vital capacity. OBJECTIVES To define which of these function parameters is the most optimal reflection of hyperinflationin in relation to patient-related outcomes. METHODS In a retrospective cohort study, data from measurements during baseline visits of eight studies were pooled. Primary outcomes were RV/TLC ratio and RV as percentage of predicted (RV%pred), both measured by bodyplethysmography, compared to the patient-related outcome variables: 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC). RESULTS Two hundred seventy-four COPD patients (mean age 59 years; 66% female), FEV1 0.74 ± 0.28 L, RV 4.94 ± 1.06 L, 6MWD of 339 ± 95 m, were included in the analysis. Significant correlations (all p < 0.01) were found between RV%pred and 6MWD (r = - 0.358), SGRQ (r = 0.184), and mMRC (r = 0.228). Also, there was a significant correlation between RV/TLC ratio and 6MWD (r = - 0.563), SGRQ (r = 0.289) and mMRC (r = 0.354). Linear regression analyses showed that RV/TLC ratio was a better predictor of patient outcomes than RV%pred. CONCLUSION This study demonstrates that both RV/TLC ratio and RV%pred are relevant indicators of hyperinflation in patients with severe emphysema in relation to patient-related outcomes. RV/TLC ratio is more strongly related to the patient-related outcomes than RV%pred.
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Affiliation(s)
- Wouter W de Weger
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nick H Ten Hacken
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marlies van Dijk
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jorine E Hartman
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases AA11, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Emerging Interventional Pulmonary Therapies for Chronic Obstructive Pulmonary Disease. J Thorac Imaging 2020; 34:248-257. [PMID: 31145187 DOI: 10.1097/rti.0000000000000424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease is a condition characterized by progressive airflow limitation caused by airway and parenchymal inflammation. Current medical therapies, including bronchodilators, corticosteroids, and anti-inflammatory medications, have been shown to variably improve pulmonary function or quality of life without providing a long-term mortality benefit. Mortality benefits to therapy have been demonstrated in only 2 therapeutic interventions to date: long-term use of daily supplemental oxygen and surgical lung volume reduction (LVRS) for upper-lobe-predominant disease in patients with a low baseline exercise capacity. Newer bronchoscopic techniques for lung volume reduction (bLVR) have attracted interest from clinicians and researchers. To achieve successful results, these advanced therapies require an interdisciplinary approach between general and interventional pulmonologists and thoracic radiologists. In this article, we aim to review the latest interventional pulmonary techniques for treatment of chronic obstructive pulmonary disease with an emphasis on bLVR. We will review the bLVR preprocedure imaging evaluation, postprocedure imaging findings, and explore the potential benefits and risks of therapy based on the most recent clinical trial evidence.
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Abstract
AbstractSevere emphysema with hyperinflation presents a therapeutic challenge. Inhaled medication has limited efficacy in individuals with mechanical constraints to the respiratory pump and impaired gas exchange. Lung volume reduction surgery (LVRS) reestablishes some semblance of normal physiology, resecting grossly expanded severely diseased tissue to restore the function of compromised relatively healthy lung, and has been shown to significantly improve exercise capacity, quality of life, and survival, especially in individuals with upper-lobe predominant emphysema and low-baseline exercise capacity, albeit with higher early morbidity and mortality. Bronchoscopic lung volume reduction achieved by deflating nonfunctioning parts of the lung is promoted as a less invasive and safer approach. Endobronchial valve implantation has demonstrated comparable outcomes to LVRS in selected individuals and has recently received approvals by the National Institute of Clinical Excellence in the United Kingdom and the Food and Drug Administration in the United States of America. Endobronchial coils are proving a viable treatment option in severe hyperinflation in the presence of collateral ventilation in selected cases of homogeneous disease. Modalities including vapor and sealant are delivered using a segmental strategy preserving healthier tissue within the same target lobe-efficacy and safety-data are, however, limited. This article will review the data supporting these novel technologies.
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Affiliation(s)
- Justin L. Garner
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom
- Airways Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Pallav L. Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom
- Airways Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Welling JBA, Hartman JE, Augustijn SWS, Kerstjens HAM, Vanfleteren LEGW, Klooster K, Slebos DJ. Patient Selection for Bronchoscopic Lung Volume Reduction. Int J Chron Obstruct Pulmon Dis 2020; 15:871-881. [PMID: 32368033 PMCID: PMC7185646 DOI: 10.2147/copd.s240848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Jorrit B A Welling
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jorine E Hartman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sonja W S Augustijn
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Huib A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Medical Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Karin Klooster
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk-Jan Slebos
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hartman JE, Shah PL, Sciurba F, Herth FJF, Slebos DJ. Endobronchial coils for emphysema: Dual mechanism of action on lobar residual volume reduction. Respirology 2020; 25:1160-1166. [PMID: 32267059 PMCID: PMC7687244 DOI: 10.1111/resp.13816] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
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 coil-treated 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 FEV1 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.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital and Imperial College, London, UK
| | - Frank Sciurba
- Department of medicine, division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Felix J F Herth
- Thoraxklinik and Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Yildiz F. The Efficacy of Lung Volume Reduction Coil Treatment in Patients with Severe Chronic Obstructive Pulmonary Disease (COPD) Type II Respiratory Failure. Int J Chron Obstruct Pulmon Dis 2020; 15:479-486. [PMID: 32184585 PMCID: PMC7060769 DOI: 10.2147/copd.s218785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Emphysema is a progressive and irreversible disease, proceeding with the decrease in elastic recoil which is connected to tissue damage caused by chronic inflammation. Lung volume reduction coil (LVRC) method in patients with an advanced level of emphysema and irresponsive to medical treatment is shown to provide increase in lung volumes and exercise capacity, decrease in dyspnea, and increase in quality of life. The purpose of this study is to reveal that LVRC treatment is also efficient in severe COPD patients with hypercapnic respiratory failure. Patients and Methods Eleven cases with severe COPD and emphysema were included in the study. LVRC treatment method was applied in upper lobes of both lungs in patients with severe COPD (FEV1 < %45) and Type-2 respiratory insufficiency (PCO2 55-80 mmHg) who were having medical treatment and CPAP treatment. The patients were followed up for a period of twelve months using arterial blood gas analysis. Results Beginning with the first month of the LVRC treatment, PCO2 levels were found to be significantly decreased in all patients using arterial blood gas analysis. Conclusion LVRC method can provide physiological and functional recovery and progress in quality of life in severe COPD cases. It is demonstrated that LVRC treatment caused significant decreases in carbon dioxide levels as well as causing improvement in life quality and respiratory function tests in the patients with hypercapnic respiratory failure.
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Affiliation(s)
- Fidan Yildiz
- Okan University, Okan University Chest Diseases, İçmeler, Turkey
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69
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Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease is a heterogeneous syndrome associated with varying degrees of parenchymal emphysema and airway inflammation resulting in decreased expiratory flow, lung hyperinflation, and symptoms leading to decreased exercise tolerance and quality of life. Impairment in lung function and quality of life persists following guideline-based medical therapy, thus surgical and minimally invasive bronchoscopic approaches were developed to address this unmet need. We offer a narrative review of the available technologies. RECENT FINDINGS Although lung volume reduction surgery has been shown to improve survival in appropriately selected patients, it is infrequently performed. Less invasive bronchoscopic procedures have thus been explored including endobronchial valves, coils, lung sealant, thermal vapor, and other airway approaches. Selection criteria including severity of physiologic and radiographic impairment, degree of lung hyperinflation, presence of intact fissures, type of symptoms, and presence of comorbidities are critical in selecting appropriate candidates. SUMMARY Recent advances in minimally invasive approaches to lung volume reduction have offered alternatives to surgical approaches. Two endobronchial valve devices are Food and Drug Administration approved for clinical use, and investigations into alternative bronchoscopic therapies to treat both emphysema and chronic bronchitis have been performed or are currently underway. Notably, each of these treatments requires unique selection criteria and thus a personalized approach to treatment.
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70
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Orton CM, Garner JL, Desai SR, Kemp SV, Shah PL. Aspergillus Cavitation Complicating Endobronchial Lung Volume Reduction Coil Placement. Am J Respir Crit Care Med 2020; 201:e8-e9. [PMID: 31469578 DOI: 10.1164/rccm.201906-1176im] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christopher Michael Orton
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, United Kingdom; and
| | - Justin L Garner
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, United Kingdom; and
| | | | - Samuel V Kemp
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, United Kingdom; and
| | - Pallav L Shah
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, United Kingdom; and.,Chelsea & Westminster Hospital, London, United Kingdom
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Garner J, Kemp S, Srikanthan K, Caneja C, Zoumot Z, Roberts C, Banya W, Chaudhuri R, Bicknell S, Ross E, LaPrad A, Shah P. 5-Year Survival after Endobronchial Coil Implantation: Secondary Analysis of the First Randomised Controlled Trial, RESET. Respiration 2020; 99:154-162. [DOI: 10.1159/000505274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
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Xu W, Wang J, He X, Wang J, Wu D, Li G. Bronchoscopic lung volume reduction procedures for emphysema: A network meta-analysis. Medicine (Baltimore) 2020; 99:e18936. [PMID: 32000409 PMCID: PMC7004743 DOI: 10.1097/md.0000000000018936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) offers alternative novel treatments for patients with emphysema. Comprehensive evidence for comparing different BLVR remains unclear. To estimate the effects of different BLVR on patients with emphysema. PubMed, EMBASE, Cochrane Library, and Web of Science databases from January 2001 to August 2017 were searched. Randomized clinical trials evaluated effects of BLVR on patients with emphysema. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk of bias tools. Pair-wise metaanalyses were made using the random-effects model. A random-effects network meta-analysis was applied within a Bayesian framework. The quality of evidence contributing to primary outcomes was assessed using the GRADE framework. 13 trials were deemed eligible, including 1993 participants. The quality of evidence was rated as moderate in most comparisons. Medical care (MC)was associated with the lowest adverse events compared with intrabronchial valve (IBV)(-2.5,[-4.70 to -0.29]), endobronchial valve (EBV) (-1.73, [-2.37 to -1.09]), lung volume reduction coils (LVRC) (-0.76, [-1.24 to -0.28]), emphysematous lung sealant (ELS) (-1.53, [-2.66 to -0.39]), and airway bypass(-1.57, [-3.74 to 0.61]). Adverse events in LVRC were lower compared with ELS (-0.77,[-2.00 to 0.47]). Bronchoscopic thermal vapor ablation (BTVA) showed significant improvement in FEV1 compared with MC (0.99, [0.37 to 1.62]), IBV (1.25, [0.25 to 2.25]), and LVRC (0.72, [0.03 to 1.40] ). Six minute walking distance (6 MWD) in ELS was significantly improved compared with other four BLVR, sham control, and MC (-1.96 to 1.99). Interestingly, MC showed less improvement in FEV1 and 6MWDcompared with EBV (-0.45, [-0.69 to -0.20] and -0.39, [-0.71 to -0.07], respectively). The mortality in MC and EBV was lower compared with LVRC alone (-0.38, [-1.16 to 0.41] and -0.50, [-1.68 to 0.68], respectively). BTVA and EBV led to significant changes in St George's respiratory questionnaire (SGRQ) compared with MC alone (-0.74, [-1.43 to -0.05] and 0.44, [0.11 to 0.78], respectively). BLVR offered a clear advantage for patients with emphysema. EBV had noticeable beneficial effects on the improvement of forced expiratory volume 1, 6MWD and SGRQ, and was associated with lower mortality compared with MC in different strategies of BLVR.
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Biener L, Skowasch D, Hollmann S, Schreiber T, Nickenig G, Fimmers R, Pizarro C. Endoscopic Lung Volume Reduction in COPD: The Impact of Coil Implantation on Patients' Physical Activity. Respiration 2019; 99:177-180. [PMID: 31846975 DOI: 10.1159/000504678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
Endoscopic lung volume reduction (ELVR) is an emerging therapy option for the treatment of severe emphysema in COPD. To which extent patients profit from lung volume reduction via coils (LVRC) regarding morbidity, mortality, and quality of life is not clear yet. In this monocentric prospective cohort study, 13 COPD patients with severe emphysema (residual volume [RV] >225%) were enrolled at the University Hospital of Bonn. Activity measurements were assessed by a validated accelerometer wristband. By LVRC, RV could be reduced by 0.13 L to 5.54 ± 1.29 L. We could show a clinically relevant improvement in patients' physical activity after LVRC, measured as daily step count (497.7 ± 72.6 vs. 1,913.7 ± 182.7 steps/day, p = 0.03) and mean daily active energy expenditure (714.4 ± 73.6 vs. 2,321.3 ± 163.9 joules, p = 0.03). This improvement in physical activity is possibly associated with a positive effect on patients' morbidity and mortality.
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Affiliation(s)
- Leonie Biener
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany,
| | - Dirk Skowasch
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany
| | - Sophia Hollmann
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany
| | - Tina Schreiber
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, Germany
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Screening for Bronchoscopic Lung Volume Reduction: Reasons for Not Receiving Interventional Treatment. Lung 2019; 198:221-228. [PMID: 31832749 DOI: 10.1007/s00408-019-00303-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evidence for bronchoscopic lung volume reduction (BLVR) is based on phase 2 studies and small randomized controlled trials with in- and exclusion criteria defining a therapeutic window and contraindications. Little is known about the applicability in routine clinical practice. AIM Which percentage of patients with severe emphysema referred to a specialized treatment center for BLVR is ultimately suitable for interventional bronchoscopic treatment? What is the relevance of the different contraindications? METHODS Retrospective evaluation of emphysema patients referred to Asklepios Fachkliniken Munich-Gauting for BLVR between January 2014 and June 2015. RESULTS 138 patients were referred for evaluation of BLVR. 38 patients (27.5%) underwent BLVR procedures (valves n = 18; coils n = 18; thermal vapor ablation n = 2). 100 patients (72.5%) were deemed not eligible for BLVR based on the following contraindications: 34% emphysema morphology and emphysema-related findings (severe homogeneous emphysema, extensive pleuropulmonary adhesions, postinflammatory scaring with natural volume reduction, giant bullae), 16% active smoking; 9% pulmonary function not within indication range; 8% unexpected CT findings (nodules, cancer, interstitial disease); 8% chronic ventilatory failure; 8% patient refused BLVR; 5% relevant comorbidity; 5% frequent exacerbations, 3% preserved quality of life, 4% other. CONCLUSION BLVR is a therapeutic option for highly selected patients. In our cohort, one in four could be treated. These data highlight the limitations of BLVR under real-life conditions.
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Bilaçeroğlu S. Interventional Bronchoscopy in the Management of Chronic Obstructive Lung Disease. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190211155026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is characterized by airflow
limitation, hyperinflation and reduced gas exchange that lead to progressive dyspnea. Pulmonary
rehabilitation, lifestyle changes, pharmacotherapy, long-term oxygen therapy, noninvasive
ventilation and surgical therapeutic approaches are the basic management strategies.
Purpose:
In the last 15 years, various bronchoscopic therapeutic modalities have emerged for severe
COPD. The aim of this review is to summarize the effects of these bronchoscopic treatments
compared with lung rehabilitation and pharmacological therapies.
Methods:
A PubMed search for the eligible studies and reviews on interventional bronchoscopy and
COPD has been conducted.
Results:
Bronchoscopic lung volume reduction (LVR) techniques are targeted to reduce
hyperinflation. The efficacy of reversible valve implantation has been confirmed in several
randomized controlled trials. It provides clinical benefit in the absence of interlobar collateral
ventilation. Nonblocking bronchoscopic LVR with coils, thermal vapor or sealants is independent of
collateral ventilation but has not been studied sufficiently. Partially irreversible coil implantation
leads to parenchymal compression while irreversible LVR with thermal vapor or sealants induce an
inflammatory reaction. Targeted lung denervation ablates parasympathetic pulmonary nerves in
COPD for sustainable bronchodilation, and liquid nitrogen metered cryospray destroys hyperplastic
goblet cells and excessive submucous glands in the central airways to induce mucosal regeneration in
chronic bronchitis.
Conclusion:
The best-examined bronchoscopic LVR method is the valve therapy. The data from the
other modalities are still limited. Further studies are required to select the patients that will optimally
benefit from a particular treatment and to predict and treat the procedure-related complications.
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Affiliation(s)
- Semra Bilaçeroğlu
- Department of Pulmonary Medicine, Health Sciences University, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey
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Computed Tomography Imaging for Novel Therapies of Chronic Obstructive Pulmonary Disease. J Thorac Imaging 2019; 34:202-213. [PMID: 30550404 DOI: 10.1097/rti.0000000000000378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Novel therapeutic options in chronic obstructive pulmonary disease (COPD) require delicate patient selection and thus demand for expert radiologists visually and quantitatively evaluating high-resolution computed tomography (CT) with additional functional acquisitions such as paired inspiratory-expiratory scans or dynamic airway CT. The differentiation between emphysema-dominant and airway-dominant COPD phenotypes by imaging has immediate clinical value for patient management. Assessment of emphysema severity, distribution patterns, and fissure integrity are essential for stratifying patients for different surgical and endoscopic lung volume reduction procedures. This is supported by quantitative software-based postprocessing of CT data sets, which delivers objective emphysema and airway remodelling metrics. However, the significant impact of scanning and reconstruction parameters, as well as intersoftware variability still hamper comparability between sites and studies. In earlier stage COPD imaging, it is less clear as to what extent quantitative CT might impact decision making and therapy follow-up, as emphysema progression is too slow to realistically be useful as a mid-term outcome measure in an individual, and longitudinal data on airway remodelling are still very limited.
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Chaddha U, Lin J, Hogarth DK. Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: How to Do It. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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78
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Herth FJF, Slebos DJ, Shah PL, Hetzel M, Schmid-Bindert G, LaPrad AS, Deslée G, Valipour A. Protocol of a Randomized Controlled Study of the PneumRx Endobronchial Coil System versus Standard-of-Care Medical Management in the Treatment of Subjects with Severe Emphysema (ELEVATE). Respiration 2019; 98:512-520. [PMID: 31743933 DOI: 10.1159/000502100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The PneumRx endobronchial coil system for patients with severe emphysema has been shown to improve quality of life, exercise capacity, and pulmonary function in patients with emphysema. A post hoc analysis of the RENEW trial has identified patient characteristics and lobar selection methods associated with improved outcomes, which have to be confirmed prospectively. METHODS The ELEVATE trial is a prospective, multicenter, open label, randomized (2:1), controlled trial comparing outcomes in patients treated with endobronchial coils (treatment) to a medically managed control group (control). The trial aims to enroll 210 patients (140 in the treatment group and 70 in the control group) with severe emphysema. Control patients will be eligible to crossover to coil treatment after 6 months of follow-up. The co-primary effectiveness endpoints are percent change in forced expiratory volume in 1 s and quality of life measured by change in St. George's Respiratory Questionnaire from baseline to 6 months. Secondary objectives are determination of responder rates of clinical endpoints and mean change in other functional and physiologic endpoints. All patients will be followed for 24 months after initial treatment. Adverse events will be collected on an ongoing basis throughout the trial. DISCUSSION The primary objective of the ELEVATE trial is to prospectively confirm the safety and effectiveness profile of the coil system for the treatment of severe emphysema in consideration of the findings of previous randomized controlled trials. Secondary objectives are the determination of responder rates in all clinical endpoints and mean change in physiologic endpoints.
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Affiliation(s)
- Felix J F Herth
- Thoraxklinik and Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pallav L Shah
- Royal Brompton Hospital and Chelsea and Westminster Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Gerald Schmid-Bindert
- PneumRx GmbH, a BTG International Group Company, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Adam S LaPrad
- PneumRx, Inc., a BTG International Group Company, Santa Clara, California, USA
| | - Gaëtan Deslée
- University Hospital of Reims, INSERM U1250, Reims, France
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Department of Respiratory and Critical Care Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria,
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79
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Pierret T, Briault A, Reymond E, Benet J, Arbib F, Pison C. [An acute complication following emphysema reduction with coils]. Rev Mal Respir 2019; 36:1073-1076. [PMID: 31629604 DOI: 10.1016/j.rmr.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Affiliation(s)
- T Pierret
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, centre hospitalier et universitaire Grenoble Alpes, 38700 La Tronche 9, France; Université Grenoble Alpes, CS40700, 38058 Grenoble cedex 9, France.
| | - A Briault
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, centre hospitalier et universitaire Grenoble Alpes, 38700 La Tronche 9, France
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale, CHU Grenoble Alpes, 38700 La Tronche, France
| | - J Benet
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, centre hospitalier et universitaire Grenoble Alpes, 38700 La Tronche 9, France; Université Grenoble Alpes, CS40700, 38058 Grenoble cedex 9, France
| | - F Arbib
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, centre hospitalier et universitaire Grenoble Alpes, 38700 La Tronche 9, France
| | - C Pison
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, centre hospitalier et universitaire Grenoble Alpes, 38700 La Tronche 9, France; Université Grenoble Alpes, CS40700, 38058 Grenoble cedex 9, France
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80
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Plante A, Guinde J, Boudreau C, Maltais F, Martel S, Delage A, Fortin M. A Rare Complication: Development of an Aspergilloma after Endobronchial Coil Placement in a COPD Patient. Respiration 2019; 99:423-425. [PMID: 31622972 DOI: 10.1159/000503363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/14/2019] [Indexed: 11/19/2022] Open
Abstract
Endobronchial coils are a relatively novel endoscopic lung volume reduction modality that aims to increase functional capacity in chronic obstructive pulmonary disease (COPD) patients. Two major trials have studied the safety and efficacy of this therapy, but long-term safety has not been studied. Adverse events reported are mainly periprocedural pneumothoraces and early bacterial infectious complications. We report the case of a patient with severe emphysema (Global Initiative for Chronic Obstructive Lung Disease stage IV COPD) who developed endobronchial coil-associated aspergillomas 3 years after coil placement.
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Affiliation(s)
- Alexandre Plante
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Julien Guinde
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada.,Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Christine Boudreau
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Simon Martel
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Antoine Delage
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Marc Fortin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada,
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81
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Criner GJ, Sue R, Wright S, Dransfield M, Rivas-Perez H, Wiese T, Sciurba FC, Shah PL, Wahidi MM, de Oliveira HG, Morrissey B, Cardoso PFG, Hays S, Majid A, Pastis N, Kopas L, Vollenweider M, McFadden PM, Machuzak M, Hsia DW, Sung A, Jarad N, Kornaszewska M, Hazelrigg S, Krishna G, Armstrong B, Shargill NS, Slebos DJ. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med 2019; 198:1151-1164. [PMID: 29787288 DOI: 10.1164/rccm.201803-0590oc] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months. OBJECTIVES To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe. METHODS Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was the ΔEBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of greater than or equal to 15%. Secondary endpoints included absolute changes in post-bronchodilator FEV1, 6-minute-walk distance, and St. George's Respiratory Questionnaire scores. MEASUREMENTS AND MAIN RESULTS A total of 190 subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a ΔFEV1 greater than or equal to 15% (P < 0.001). ΔEBV-SoC at 12 months was statistically and clinically significant: for FEV1, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P = 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P = 0.004). Significant ΔEBV-SoC were also observed in hyperinflation (residual volume, -522 ml; P < 0.001), modified Medical Research Council Dyspnea Scale (-0.8 points; P < 0.001), and the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points). Pneumothorax was the most common serious adverse event in the treatment period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths occurred in the EBV group during this phase, and one each in the EBV and SoC groups between 46 days and 12 months. CONCLUSIONS Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe. Clinical trial registered with www.clinicaltrials.gov (NCT 01796392).
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Affiliation(s)
- Gerard J Criner
- 1 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard Sue
- 2 St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Shawn Wright
- 2 St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark Dransfield
- 3 University of Alabama at Birmingham UAB Lung Health Center, Birmingham, Alabama
| | - Hiram Rivas-Perez
- 4 Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Tanya Wiese
- 4 Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Frank C Sciurba
- 5 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pallav L Shah
- 6 Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Momen M Wahidi
- 7 Duke University Medical Center, Duke University, Durham, North Carolina
| | | | - Brian Morrissey
- 9 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Sacramento, California
| | - Paulo F G Cardoso
- 10 Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven Hays
- 11 University of California, San Francisco, San Francisco, California
| | - Adnan Majid
- 12 Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicholas Pastis
- 13 Medical University of South Carolina, Charleston, South Carolina
| | - Lisa Kopas
- 14 Pulmonary Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, Texas
| | - Mark Vollenweider
- 15 Orlando Health Pulmonary and Sleep Medicine Group, Orlando Regional Medical Center, Orlando, Florida
| | - P Michael McFadden
- 16 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael Machuzak
- 17 Center for Major Airway Diseases, Cleveland Clinic, Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio
| | - David W Hsia
- 18 Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance, California
| | - Arthur Sung
- 19 Stanford Hospital and Clinics, Stanford, California
| | - Nabil Jarad
- 20 University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malgorzata Kornaszewska
- 21 Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Stephen Hazelrigg
- 22 Division of Cardiothoracic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ganesh Krishna
- 23 Palo Alto Medical Foundation, El Camino Hospital, Mountain View, California
| | | | | | - Dirk-Jan Slebos
- 26 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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82
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Effects of Bronchoscopic Lung Volume Reduction Coil Treatment on Arterial Blood Gases. J Bronchology Interv Pulmonol 2019; 26:90-95. [PMID: 30640825 DOI: 10.1097/lbr.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) coil treatment is an increasingly used treatment modality for selected severe emphysema patients in recent years. Emphysema causes dynamic hyperinflation, loss of elastic recoil, air trapping, and decreased exercise capacity in advanced stages. This process progresses over time, leading to hypoxic and hypercapnic respiratory failure. The goal of this study is to elucidate the effects of BLVR coil treatment on arterial blood gas parameters in severe emphysema patients with respiratory failure. METHODS This is a retrospective study performed at a single pneumology center in Turkey. In total, this study included 39 patients diagnosed with severe emphysema who underwent bilateral BLVR coil treatment according to the general inclusion and exclusion criteria in the literature. The patients baseline and 12-month data were collected from medical records. RESULTS Twelve months after BLVR coil treatment, significant improvements were observed in patients' pulmonary function tests, an increase in partial pressure of oxygen in arterial blood (PaO2) from 58.05±9.36 to 73.82±13.3 (P<0.000) and decrease in partial pressure of carbon dioxide in arterial blood (PaCO2) of hypercapnic patients (from 51.60±4.1 to 46.55±6.6 mm Hg; P=0.001). CONCLUSION BLVR coil treatment is reliable and effective in emphysema patients who have hypoxic or mild hypercapnic respiratory failure. Besides improving lung function, BLVR coil treatment can significantly increase PaO2 and decrease PaCO2 in the medium term.
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83
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Mal H, Bunel V, Marceau A, Dombret M, Debray M, Crestani B. Réduction de volume pulmonaire endoscopique dans l’emphysème. Rev Mal Respir 2019; 36:880-888. [DOI: 10.1016/j.rmr.2019.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/28/2018] [Indexed: 01/03/2023]
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84
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Polke M, Rötting M, Sarmand N, Krisam J, Eberhardt R, Herth FJF, Gompelmann D. Interventional therapy in patients with severe emphysema: evaluation of contraindications and their incidence. Ther Adv Respir Dis 2019; 13:1753466619835494. [PMID: 30874483 PMCID: PMC6421604 DOI: 10.1177/1753466619835494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Endoscopic and surgical interventions may be beneficial for selected patients with emphysema. Rates of treatment failure decrease when the predictors for successful therapy are known. The aim of the study was to evaluate the number of patients with severe emphysema who were not eligible for any intervention, and the reasons for their exclusion. Methods: The study was a retrospective analysis of 231 consecutive patients with advanced emphysema who were considered for interventional therapy in 2016 at the Thoraxklinik, Heidelberg, Germany. The reasons for not receiving valve or coil therapy were assessed for all patients who did not receive any therapy. Results: Of the 231 patients, 50% received an interventional therapy for lung volume reduction (LVR) (82% valve therapy, 6% coil therapy, 4.3% polymeric LVR or bronchial thermal vapour ablation, 4.3% total lung denervation, and 3.4% lung volume reduction surgery [LVRS]). A total of 115 patients did not undergo LVR. Out of these, valve or coil therapy was not performed due to one or more of the following reasons: incomplete fissure in 37% and 0%; missing target lobe in 31% and 30%; personal decision in 18% and 28%; pulmonary function test results in 8% and 15%; ventilatory failure in 4% and 4%; missing optimal standard medical care and/or continued nicotine abuse in 4% and 3%; general condition too good in less than 1% and 3%; cardiovascular comorbidities in 0% and 3%; age of patient in 0% and less than 1%. Both techniques were not performed due to one or more of the following reasons: solitary pulmonary nodule(s)/consolidation in 27%; bronchopathy in 7%; neoplasia in 2%; destroyed lung in 2%; prior LVRS in less than 1%. Conclusions: The main reason for not placing valves was an incomplete fissure and for coils a missing target lobe. Numerous additional contraindications that may exclude a patient from interventional emphysema therapy should be respected.
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Affiliation(s)
- Markus Polke
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany
| | - Matthias Rötting
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Nilab Sarmand
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research), Heidelberg, Germany
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research), Heidelberg, Germany
| | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research), Heidelberg, Germany
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85
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Shen M, Tenda ED, McNulty W, Garner J, Robbie H, Luzzi V, Aboelhassan AM, Van Geffen WH, Kemp SV, Ridge C, Devaraj A, Shah PL, Yang GZ. Quantitative Evaluation of Lobar Pulmonary Function of Emphysema Patients with Endobronchial Coils. Respiration 2019; 98:70-81. [PMID: 31238320 DOI: 10.1159/000499622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent advances in bronchoscopic lung volume reduction offer new therapies for patients with emphysema and hyperinflation. Pulmonary lobe segmentation with quantification of lobar volumes and emphysema severity plays a pivotal role in treatment planning and post-interventional assessment. Computed tomography (CT)-derived lobar volumes could reflect more accurate regional changes in pulmonary function. OBJECTIVES The aim of our study is to validate the reliability of an in-house CT Lung Segmentation software (LungSeg; the Hamlyn Centre, Imperial College London, UK) for lung lobar volume and emphysema quantification for chronic obstructive pulmonary disease (COPD) patients. METHODS A total of 108 CT scans from subjects who participated in an endobronchial coil treatment trial were included. Lobar volume and emphysema quantification were performed using the LungSeg and Syngo CT Pulmo 3D package (Siemens Healthcare GmbH, Germany). The inter-user reliability of the LungSeg program was investigated. Correlation coefficients and Bland-Altman analyses were used to quantify the inter-software variability. The agreement between CT volume analysis and plethysmography analysis was also examined. RESULTS The high intraclass correlation coefficients (mean ICC = 0.98) of the lobar volumes and emphysema indices measured by LungSeg suggest its excellent reproducibility. The LungSeg and Syngo program have good correlation (rho ≥0.94) and agreement for both lobar volume (median difference = 94 mL and LOAnp = 214.6 mL) and emphysema index (median difference ≤1.5% and LOAnp ≤2.03%) calculations. CT analysis provides a higher estimation of total lung capacity (TLCCT) than body plethysmography (TLCpleth), while there is a fair agreement on residual volume (RVCT) by LungSeg as compared with body plethysmography (RVpleth). CONCLUSIONS CT-derived lobar volume and emphysema quantification using the LungSeg program is efficient and reliable in allowing lobar volume assessment. LungSeg has low inter-user variability and agrees better with plethysmography for COPD assessment in our study.
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Affiliation(s)
- Mali Shen
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom,
| | - Eric D Tenda
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Division of Pulmonology, Department of Internal Medicine, National General Hospital of Dr. Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - William McNulty
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Justin Garner
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Hasti Robbie
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Valentina Luzzi
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Arafa M Aboelhassan
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Assiut University Hospital, Faculty of Medicine, Assiut, Egypt
| | - Wouter H Van Geffen
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
| | - Samuel V Kemp
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Carole Ridge
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Anand Devaraj
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.,Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
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86
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Dutau H, Deslée G, Bregeon F, Astoul P, Thomas P. Successful Lung Volume Reduction Surgery after Endobronchial Coils Treatment in a Severe Emphysematous Patient. Respiration 2019; 98:174-177. [PMID: 31117089 DOI: 10.1159/000499682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/16/2019] [Indexed: 11/19/2022] Open
Abstract
Lung volume reduction surgery (LVRS) in emphysema has demonstrated improvement in both overall survival and clinical/functional outcomes. Endobronchial coil treatment (ECT) has also demonstrated improvement in pulmonary function, exercise performance, and quality of life, although predictive factors of responders remain to be determined. We describe the first successful LVRS in an emphysematous patient who displayed no benefit, either clinically or functionally, from a previous ECT. LVRS was performed in the right lower lobe 4 years after ECT in the same lobe. An air leak persisted for 18 days after LVRS, with no requirement for surgery or endobronchial treatment. Six months after LVRS, the patient dramatically improved with a decrease in hyperinflation and dyspnea.
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Affiliation(s)
- Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France,
| | - Gaëtan Deslée
- Department of Respiratory Diseases, INSERM UMRS 1250, University Hospital, Reims, France
| | - Fabienne Bregeon
- Department of Respiratory Physiology, North Hospital of Marseille, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Pascal Thomas
- Department of Thoracic Surgery, North University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
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87
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Azadeh N, Clay RD, Braus NA, Ramar K. Cryobiopsy, Endobronchial Ultrasound Staging of the Mediastinum, and Endobronchial Coils. Am J Respir Crit Care Med 2019; 195:394-396. [PMID: 27911567 DOI: 10.1164/rccm.201609-1840rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Natalya Azadeh
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan D Clay
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicholas A Braus
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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88
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Tenda ED, Ridge CA, Shen M, Yang GZ, Shah PL. Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema. Respiration 2019; 98:86-94. [PMID: 31067563 DOI: 10.1159/000498949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Recent advances in bronchoscopic lung volume reduction (BLVR) offer new therapeutic alternatives for patients with emphysema and hyperinflation. Endobronchial valves and coils are 2 potential BLVR techniques which have been shown to improve pulmonary function and the quality of life in patients with emphysema. Current patient selection for LVR procedures relies on 3 main inclusion criteria: low attenuation area (in %), also known as emphysema score, heterogeneity score, and fissure integrity score. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative CT to determine emphysema severity play an important role in treatment planning and post-operative assessment. Due to the variations in lung anatomy, manual corrections are often required to ensure successful and accurate lobe segmentation for pathological and post-treatment CT scan analysis. The advanced development and utilisation of quantitative CT do not simply represent regional changes in pulmonary function but aids in analysis for better patient selection with severe emphysema who are most likely to benefit from BLVR.
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Affiliation(s)
- Eric Daniel Tenda
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.,Division of Pulmonology, Department of Internal Medicine, National General Hospital of Dr. Cipto Mangunkusumo, and Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carole A Ridge
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Mali Shen
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Pallav L Shah
- National Heart and Lung Institute, Imperial College, London, United Kingdom, .,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom,
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89
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Petousi N, Talbot NP, Pavord I, Robbins PA. Measuring lung function in airways diseases: current and emerging techniques. Thorax 2019; 74:797-805. [PMID: 31036773 DOI: 10.1136/thoraxjnl-2018-212441] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Chronic airways diseases, including asthma, COPD and cystic fibrosis, cause significant morbidity and mortality and are associated with high healthcare expenditure, in the UK and worldwide. For patients with these conditions, improvements in clinical outcomes are likely to depend on the application of precision medicine, that is, the matching of the right treatment to the right patient at the right time. In this context, the identification and targeting of 'treatable traits' is an important priority in airways disease, both to ensure the appropriate use of existing treatments and to facilitate the development of new disease-modifying therapy. This requires not only better understanding of airway pathophysiology but also an enhanced ability to make physiological measurements of disease activity and lung function and, if we are to impact on the natural history of these diseases, reliable measures in early disease. In this article, we outline some of the key challenges faced by the respiratory community in the management of airways diseases, including early diagnosis, disease stratification and monitoring of therapeutic response. In this context, we review the advantages and limitations of routine physiological measurements of respiratory function including spirometry, body plethysmography and diffusing capacity and discuss less widely used methods such as forced oscillometry, inert gas washout and the multiple inert gas elimination technique. Finally, we highlight emerging technologies including imaging methods such as quantitative CT and hyperpolarised gas MRI as well as quantification of lung inhomogeneity using precise in-airway gas analysis and mathematical modelling. These emerging techniques have the potential to enhance existing measures in the assessment of airways diseases, may be particularly valuable in early disease, and should facilitate the efforts to deliver precision respiratory medicine.
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Affiliation(s)
- Nayia Petousi
- Nuffield Department of Clinical Medicine Division of Experimental Medicine, University of Oxford, Oxford, UK .,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nick P Talbot
- Nuffield Department of Clinical Medicine Division of Experimental Medicine, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ian Pavord
- Nuffield Department of Clinical Medicine Division of Experimental Medicine, University of Oxford, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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90
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Hu Y, Cheng Y, Zhang H, Li A, Li S, Wang G. A New-Designed Lung-Bending Device for Bronchoscopic Lung Volume Reduction of Severe Emphysema: A Feasibility Study in Pigs. Respiration 2019; 97:444-450. [PMID: 30947231 DOI: 10.1159/000495142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic therapies are less invasive alternatives of surgical lung volume reduction for severe emphysema. Bending of lung tissue by implanting metallic coils into bronchi is one of the procedures. A new-designed device with a similar rationale, Reverser, has been developed with some improvements. OBJECTIVES The aim of the study was to evaluate the safety and feasibility of the Reversers. METHODS Twelve healthy pigs were randomly divided into 3 groups (groups A, B, and C). The Reversers were implanted bronchoscopically into the selected airways using a proprietary delivery system. Physical examination, chest fluoroscopy, computed tomography (CT) scans, and bronchoscopic observations were performed before implantation and during the follow-up period. Necropsy was performed respectively at 1 month (group A), 3 months (group B), and 6 months (group C) after implantation. RESULTS A total of 47 Reversers were implanted successfully. The procedure was feasible and well tolerated by all pigs. No severe complications, such as pneumothorax, abscesses, and airway hemorrhage, were found. No unintended injuries or death occurred. Mild granulation and inflammation were observed in the airway wall. Opacities around Reversers were shown on CT scans in some pigs. In the pigs with opacities, histological evaluation revealed widened alveolar septa due to inflammatory cell infiltration in the vicinity of the Reversers. On the analysis of CT data, there was a trend for volume reduction of the treated lung at 1 and 3 months after treatment compared with baseline. CONCLUSIONS This study showed that Reversers were safe and feasible for bronchoscopic lung volume reduction in pigs.
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Affiliation(s)
- Yan Hu
- Department of Respiratory and Critical Care Medicine of Peking University First Hospital, Beijing, China
| | - Yuan Cheng
- Department of Respiratory and Critical Care Medicine of Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine of Peking University First Hospital, Beijing, China
| | - Anning Li
- Lifetech Scientific Corp., Shenzhen, China
| | - Siyi Li
- Lifetech Scientific Corp., Shenzhen, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine of Peking University First Hospital, Beijing, China,
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91
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Doellinger F, Theilig DC, Feldhaus F, Hubner RH. [Imaging before and after endoscopic lung volume reduction]. Radiologe 2019; 59:369-384. [PMID: 30911778 DOI: 10.1007/s00117-019-0509-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of symptomatic lung emphysema by lung volume reduction has become established over the last 15 years. While surgical partial lung resection has profited from improved and less invasive surgical techniques, various endoscopic interventional procedures have been developed and are now available for use. All treatment approaches are dependent on individual anatomical variants and a regional distribution of the lung emphysema, which is why no procedure can be designated as the gold standard for all patients. High-resolution computed tomography can be qualitatively evaluated and provides decisive information for treatment, which is why radiologists play a particularly important role in treatment planning and aftercare of an intervention for reduction of the lung volume. This article presents the various endoscopic techniques, names the demands of the treating physician on the advising radiologist and finally describes how a treatment decision is derived from the results obtained.
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Affiliation(s)
- F Doellinger
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - D C Theilig
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - F Feldhaus
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - R-H Hubner
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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92
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Flandes J, Soto FJ, Cordovilla R, Cases E, Alfayate J. Bronchoscopic Lung Volume Reduction. Clin Chest Med 2019; 39:169-180. [PMID: 29433712 DOI: 10.1016/j.ccm.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the publication of the National Emphysema Treatment Trial study, lung volume reduction (LVR) has been considered a therapeutic alternative for patients with advanced obstructive lung disease. The high complication rate of surgical LVR has led to the development of bronchoscopic LVR (BLVR). Of the currently available BLVR alternatives, coils and unidirectional endobronchial valves lead the list. The choice of each device depends on emphysema characteristics and presence of collateral ventilation. Evaluation of these patients at centers with expertise in interventional pulmonology and management of BLVR is strongly recommended.
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Affiliation(s)
- Javier Flandes
- Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, Madrid 28040, Spain.
| | - Francisco J Soto
- Pulmonary and Critical Care, Department of Medicine, University of Tennessee Medical Center, 1940 Alcoa Hwy e, Knoxville, TN 37920, USA
| | - Rosa Cordovilla
- Bronchology and Interventional Pulmonology Unit, Salamanca University Hospital, Paseo de San Vicente 58, Salamanca 37007, Spain
| | - Enrique Cases
- Bronchology and Interventional Pulmonology Unit, La Fe University Hospital, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
| | - Javier Alfayate
- Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, Madrid 28040, Spain
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93
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Abstract
Much has changed since the last review of interventional pulmonology (IP) published in this Clinics series. The rate of development of new techniques and their complexities require IP physicians to be constantly maintaining and updating their skill set. International agreed training pathways help ensure that the interventionalists of the present and future have the required knowledge of anatomy, manual dexterity, and clinical judgment to keep up with the continuing advances that are constantly expanding IP's diagnostic and therapeutic boundaries. IP remains one of the most desirable subspecialities in pulmonology, and the technologic advances make the future an exciting one.
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Affiliation(s)
- Alastair J Moore
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Rachel M Mercer
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK; Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Ali I Musani
- Interventional Pulmonology, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, University of Colorado School of Medicine, Denver, Academic Office 1, 12631 East 17th Avenue, M/S C323, Office # 8102, Aurora, CO 80045, USA.
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94
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Herth F, Slebos DJ, Criner G, Valipour A, Sciurba F, Shah P. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation – Update 2019. Respiration 2019; 97:548-557. [DOI: 10.1159/000496122] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
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Thiboutot J, Yuan W, Park HC, Lerner AD, Mitzner W, Yarmus LB, Li X, Brown RH. Current Advances in COPD Imaging. Acad Radiol 2019; 26:335-343. [PMID: 30093217 DOI: 10.1016/j.acra.2018.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review the recent advances in available technologies for imaging COPD and present the novel optical coherence tomography (OCT) airway imaging technology. MATERIALS AND METHODS This is an unstructured review of published evidence of available pulmonary imaging technologies along with a demonstration of state-of-the-art OCT imaging technology of in vivo human and animal airways. RESULTS Advanced imaging techniques such as Magnetic Resonance (MR) imaging using hyperoloarized noble gases, micro-Computed Tomography (micro-CT), and OCT aim to further our understanding of COPD. Lung densitometry can aid in identifying an exacerbation prone phenotype which may have implications for targeting specific therapies to these individuals. MR ventilation scans have the ability to provide a functional and regional distribution of airflow obstruction offering insight into the airway and parenchymal changes induced by COPD. Micro-CT gives a near microscopic view of the terminal bronchioles and alveoli permitting study of the microarchitecture of the lung ex vivo. Optical coherence tomography can visualize the microstructure of the airway walls (epithelium, smooth muscle, blood vessels, cartilage) permitting real time in vivo as well as longitudinal evaluation of airway changes in patients with COPD. CONCLUSION Advanced imaging techniques play a vital role in expanding our current understanding of COPD.
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Affiliation(s)
- Jeffrey Thiboutot
- Johns Hopkins University, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD 21205.
| | - Wu Yuan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland
| | - Hyeon-Cheol Park
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland
| | - Andrew D Lerner
- Johns Hopkins University, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD 21205
| | - Wayne Mitzner
- Johns Hopkins University, Department of Environmental Health and Engineering, Baltimore, Maryland
| | - Lonny B Yarmus
- Johns Hopkins University, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 1830 E. Monument St. 5th Floor, Baltimore, MD 21205
| | - Xingde Li
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland
| | - Robert H Brown
- Johns Hopkins University, Department of Anesthesiology and Critical Care Medicine, Medicine, Department of Medicine, Division of Pulmonary Medicine, Department of Environmental Health and Engineering, and Department of Radiology, Baltimore, Maryland
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96
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Slebos DJ, Cicenia J, Sciurba FC, Criner GJ, Hartman JE, Garner J, Deslée G, Delage A, Jantz M, Marquette CH, Strange C, Hatipoglu U, Mehta AC, LaPrad AS, Schmid-Bindert G, Herth FJF, Shah PL. Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema. Chest 2019; 155:928-937. [PMID: 30797746 DOI: 10.1016/j.chest.2019.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Lung Volume Reduction Coil Treatment in Patients With Emphysema (RENEW) trial reported improvements in quality of life, pulmonary function, and exercise performance following endobronchial coil treatment. OBJECTIVES The purpose of this post hoc analysis was to identify baseline predictors, including quantitative CT measures, that identify patients most likely to significantly benefit from endobronchial coil therapy. METHODS Quantitative CT analysis by an independent radiology laboratory and a qualitative evaluation by five blinded experts of the baseline thoracic CT imaging were performed. Univariate and multivariate logistic regression analyses were performed to elucidate characteristics associated with clinical response. RESULTS In total, 125 patients underwent coil treatment and had evaluable 12-month follow-up results. Of these, 78 patients received treatment of lobes with the highest emphysematous destruction determined by quantitative CT analysis (quantitative visual match [QVM]+), and 47 received treatment in at least one lobe that was not the most destroyed (QVM-). From the 78 patients with QVM+ treatment, a subgroup of 50 patients (64%) was identified with baseline residual volume > 200% predicted, emphysema score > 20% low attenuation area, and absence of airway disease. In this subgroup, greater lobar residual volume reduction in the treated lobes was achieved, which was associated with significant mean ± SE improvement in FEV1 (15.2 ± 3.1%), St. George's Respiratory Questionnaire (-12 ± 2 points), and residual volume (-0.57 ± 0.13 L). DISCUSSION This post hoc analysis found that both significant hyperinflation (residual volume ≥ 200% predicted) and CT analysis are critical for patient selection and treatment planning for endobronchial coil therapy. Quantitative CT analysis is important to identify optimal lobar treatment and to exclude patients with insufficient emphysema (< 20% low attenuation area), whereas visual assessment identifies patients with signs of airway disease associated with worse outcomes. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01608490; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Justin Garner
- Royal Brompton Hospital and Chelsea and Westminster Hospital, London, UK
| | - Gaëtan Deslée
- University Hospital of Reims, INSERM U1250, Reims, France
| | - Antoine Delage
- Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | | | | | | | | | | | - Adam S LaPrad
- PneumRx, Inc., a BTG International group company, Santa Clara, CA
| | - Gerald Schmid-Bindert
- PneumRx GmbH, a BTG International group company, Düsseldorf, Germany; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Felix J F Herth
- Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Pallav L Shah
- Royal Brompton Hospital and Chelsea and Westminster Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis. THE LANCET RESPIRATORY MEDICINE 2019; 7:313-324. [PMID: 30744937 DOI: 10.1016/s2213-2600(18)30431-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe emphysema is a debilitating condition with few treatment options. Lung volume reduction procedures in the treatment of severe emphysema have shown excellent results in selected patients but their exact role remains unclear with studies reporting a wide variation in outcomes. We therefore aimed to evaluate the effects of volume reduction. METHODS We did a systematic review and meta-analysis. We searched MEDLINE on Sept 29, 2016, for trials of lung volume reduction in patients with emphysema, and we did an updated search on Embase and PubMed on June 18, 2018. We only included randomised controlled studies published in English evaluating the intervention with either sham or standard of care. Inclusion was limited to trials of techniques in which there was sustainable volume reduction. Primary outcomes were residual volume, FEV1, St George's Respiratory Questionnaire (SGRQ), and 6-min walk distance (6MWT). Secondary outcomes were severe adverse events (including mortality), short-term mortality, and overall mortality. We extracted summary level data from the trial publications and where necessary we obtained unpublished data. A random-effects model with the I2 statistic was used to determine heterogeneity and trial weight in each analysis. The study is registered with the PROSPERO database, number CRD42016045705. FINDINGS We identified 4747 references in the search, and included 20 randomised controlled trials of lung volume reduction involving 2794 participants with emphysema. Following lung volume reduction from any of the interventions in pooled analyses (ie, surgery, endobronchial valve, endobronchial coil, or sclerosing agents), the mean differences compared with the control were reduction in residual volume of 0·58 L (95% CI -0·80 to -0·37), increase in FEV1 of 15·87% (95% CI 12·27 to 19·47), improvement in 6MWT of 43·28 m (31·36 to 55·21), and reduction in the SGRQ of 9·39 points (-10·92 to -7·86). The odds ratio for a severe adverse event, which included mortality, was 6·21 (95% CI 4·02 to 9·58) following intervention. Regression analysis showed improvements relative to the degree of volume reduction: FEV1 (r2=0·86; p<0·0001), 6MWT (r2=0·77; p<0·0001), and SGRQ (r2=0·70; p<0·0001). Most studies were at high risk of bias for lack of blinding, and heterogeneity was high for some outcomes when pooled across all interventions, but was generally lower in the subgroups by intervention type. INTERPRETATION Despite limitations of high risk of bias and heterogeneity for some analyses, our results provide support that lung volume reduction in patients with severe emphysema on maximal medical treatment has clinically meaningful benefits. These benefits should be considered alongside potential adverse events. FUNDING None.
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98
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Stoller JK. Giants in Chest Medicine: Professor Atul C. Mehta, MBBS, FCCP. Chest 2019; 155:254-257. [DOI: 10.1016/j.chest.2018.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022] Open
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99
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Simon M, Harbaum L, Oqueka T, Kluge S, Klose H. Endoscopic lung volume reduction coil treatment in patients with very low FEV 1: an observational study. Ther Adv Respir Dis 2019; 12:1753466618760133. [PMID: 29480070 PMCID: PMC5937153 DOI: 10.1177/1753466618760133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Endoscopic lung volume reduction coil (LVRC) treatment is a therapeutic option for selected patients with advanced emphysema. The effects and the safety of endoscopic lung volume reduction in patients with very low forced expired volume in one second (FEV1) remain to be determined. This study was conducted to assess the effects and the safety of LVRC treatment in patients with very low FEV1. METHODS The study was performed as a retrospective observational study in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf on patients with very low FEV1, defined as an FEV1 ⩽ 20% of predicted at baseline in whom LVRC treatment was performed between 1 April 2012 and 28 February 2017. RESULTS LVRC treatment was performed in 33 patients with very low FEV1. Of these, 45.5% were female and 54.5% were male. At baseline, mean FEV1 was 0.46 ± 0.12 liters (15 ± 3% of predicted), mean forced vital capacity (FVC) was 1.61 ± 0.62 liters (42 ± 13% of predicted), mean residual volume (RV) was 6.03 ± 0.81 liters (275 ± 51% of predicted) and 6-minute walk distance was 229 ± 102 m. Bilateral LVRC treatment was completed in 21 of these patients (63.6%). Bilateral LVRC treatment led to significant improvements in functional parameters with an increase in mean FEV1 from 0.44 ± 0.11 liters to 0.54 ± 0.12 liters ( p = 0.001), equivalent to a relative improvement of 24.5 ± 26.9%, an increase in mean FVC from 1.49 ± 0.54 liters to 1.84 ± 0.49 liters ( p = 0.001), a decrease in mean RV from 6.27 ± 0.83 liters to 5.83 ± 1.09 liters ( p = 0.004) and an improvement in 6-minute walk distance from 218 ± 91 m to 266 ± 96 m ( p = 0.01). There were no cases of respiratory failure requiring mechanical ventilation and no deaths. CONCLUSIONS LVRC treatment was effective and safe in patients with very low FEV1.
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Affiliation(s)
- Marcel Simon
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Harbaum
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Oqueka
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Klose
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Rustagi N, Singh S, Dutt N, Kuwal A, Chaudhry K, Shekhar S, Kirubakaran R. Efficacy and Safety of Stent, Valves, Vapour ablation, Coils and Sealant Therapies in Advanced Emphysema: A Meta-Analysis. Turk Thorac J 2019; 20:43-60. [PMID: 30664426 DOI: 10.5152/turkthoracj.2018.18062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
Abstract
Bronchoscopic lung volume reduction (BLVR) methods have emerged as a new treatment option for patients with severe emphysema. Endobronchial valves and coils have been extensively studied. This review assesses efficacy, safety, and cost effectiveness of the BLVR procedures (stent, valves, vapor ablation, endobronchial coils, lung sealant) in patients with severe emphysema. Databases were searched until October 2016, and randomized controlled trials (RCTs) comparing available BLVR procedures to standard medical care or sham bronchoscopy were included. Random effect model and generic inverse variance approach were used for meta-analysis. Out of 381 identified records, 16 RCTs were included. As compared to recommended medical care or sham bronchoscopy, the BLVR procedures are more effective in improving quality of life [SGRQ score (WMD=-6.38; -9.12 to -3.65)] and 6MWT (WMD=24.21; 9.68-38.74) and percentage FEV1 (WMD=10.48; 7.07-13.89). Increased risk of serious adverse events (RR=2.18; 1.63-2.93), specifically for chronic pulmonary obstructive disease exacerbations and lower respiratory tract infection combined (RR=1.37; 1.07-1.75), were observed with bronchoscopic interventions, while there was no difference in number of deaths (RR=1.25; 0.79-1.99) and respiratory failure (RR=1.13; 0.57-2.21). The BLVR procedures, especially endobronchial coils, were found to be effective in the management of patients with severe emphysema irrespective of collateral ventilation. However, characterization of patients who would be most benefited from these procedures is required, and effectiveness of these procedures in long run needs to be established.
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Affiliation(s)
- Neeti Rustagi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashok Kuwal
- Department of Pulmonary Medicine, Pacific Institute of Medical Sciences, Gyan Nagar, Near Gyan Mandir School, Sector-4, Hiran Magri, Udaipur, Rajasthan, India
| | - Kirti Chaudhry
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shashank Shekhar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Richard Kirubakaran
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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