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Kayikci H, Cimen P, Katgi N. Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:506-512. [PMID: 38268657 PMCID: PMC10805047 DOI: 10.14744/semb.2023.06767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/22/2023] [Accepted: 09/07/2023] [Indexed: 01/26/2024]
Abstract
Objectives In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema. Methods The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient's records, including the modified Medical Research Council (MRC) dyspnea score, the St. George's Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated. Results Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month's mMRC score was 2.62 (p=0.007), and the mean of the 12th month's mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients' preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients' preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756). Conclusion It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.
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Affiliation(s)
- Hazal Kayikci
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Pinar Cimen
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Nuran Katgi
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
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2
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Raveling T, Rantala HA, Duiverman ML. Home ventilation for patients with end-stage chronic obstructive pulmonary disease. Curr Opin Support Palliat Care 2023; 17:277-282. [PMID: 37646583 PMCID: PMC10597445 DOI: 10.1097/spc.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF THE REVIEW The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV. RECENT FINDINGS Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach. SUMMARY Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
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Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heidi A. Rantala
- Department of Respiratory Medicine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Phogat S, Thiam F, Al Yazeedi S, Abokor FA, Osei ET. 3D in vitro hydrogel models to study the human lung extracellular matrix and fibroblast function. Respir Res 2023; 24:242. [PMID: 37798767 PMCID: PMC10552248 DOI: 10.1186/s12931-023-02548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
The pulmonary extracellular matrix (ECM) is a macromolecular structure that provides mechanical support, stability and elastic recoil for different pulmonary cells including the lung fibroblasts. The ECM plays an important role in lung development, remodeling, repair, and the maintenance of tissue homeostasis. Biomechanical and biochemical signals produced by the ECM regulate the phenotype and function of various cells including fibroblasts in the lungs. Fibroblasts are important lung structural cells responsible for the production and repair of different ECM proteins (e.g., collagen and fibronectin). During lung injury and in chronic lung diseases such as asthma, idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD), an abnormal feedback between fibroblasts and the altered ECM disrupts tissue homeostasis and leads to a vicious cycle of fibrotic changes resulting in tissue remodeling. In line with this, using 3D hydrogel culture models with embedded lung fibroblasts have enabled the assessment of the various mechanisms involved in driving defective (fibrotic) fibroblast function in the lung's 3D ECM environment. In this review, we provide a summary of various studies that used these 3D hydrogel models to assess the regulation of the ECM on lung fibroblast phenotype and function in altered lung ECM homeostasis in health and in chronic respiratory disease.
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Affiliation(s)
- Sakshi Phogat
- Department of Biology, Okanagan Campus, University of British Columbia, 3187 University Way, ASC366, Kelowna, BC, V1V1V7, Canada
| | - Fama Thiam
- Department of Biology, Okanagan Campus, University of British Columbia, 3187 University Way, ASC366, Kelowna, BC, V1V1V7, Canada
| | - Safiya Al Yazeedi
- Department of Biology, Okanagan Campus, University of British Columbia, 3187 University Way, ASC366, Kelowna, BC, V1V1V7, Canada
| | - Filsan Ahmed Abokor
- Department of Biology, Okanagan Campus, University of British Columbia, 3187 University Way, ASC366, Kelowna, BC, V1V1V7, Canada
| | - Emmanuel Twumasi Osei
- Department of Biology, Okanagan Campus, University of British Columbia, 3187 University Way, ASC366, Kelowna, BC, V1V1V7, Canada.
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
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4
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Koster TD, Dijk MV, Slebos DJ. Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update. Semin Respir Crit Care Med 2022; 43:541-551. [PMID: 35562097 DOI: 10.1055/s-0042-1747938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. It is important to carefully phenotype these patients, to select the optimal treatment option, with consideration of possible adverse events or contraindications, and it is highly recommended to discuss these treatment strategies in a multidisciplinary team. The treatment with one-way endobronchial valves has been investigated most extensively and more data are available regarding the treatment of more "marginal cases," or subsequent lung volume reduction surgery. Other bronchoscopic lung volume reduction options include treatment with coils, thermal vapor ablation, and sclerosant agents. In this review, we aim to summarize the current clinical evidence on the bronchoscopic lung volume reduction therapies and important aspects regarding optimal patient selection.
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Affiliation(s)
- T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marlies Van Dijk
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Slama A, Ceulemans LJ, Hedderich C, Boehm PM, Van Slambrouck J, Schwarz S, Vandervelde CM, Kamler M, Jaksch P, Van Raemdonck D, Hoetzenecker K, Aigner C. Lung Volume Reduction Followed by Lung Transplantation in Emphysema-A Multicenter Matched Analysis. Transpl Int 2022; 35:10048. [PMID: 35497884 PMCID: PMC9047703 DOI: 10.3389/ti.2022.10048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Objective: The impact of previous lung volume reduction surgery (LVRS) or endoscopic lung volume reduction (ELVR) on lung transplantation (LuTX) remains unclear. This study assesses the risk of previous lung volume reduction on the outcome of a later LuTX. Methods: Patients suffering from emphysema who underwent bilateral LuTX were included in this multicenter analysis. Study groups were defined as: previous LVRS, previous ELVR, controls. Imbalances were corrected by coarsened exact matching for center, gender, age, diagnosis, and BMI. A comparative analysis of intraoperative characteristics, perioperative outcome and long-term survival was performed. Results: 615 patients were included (LVRS = 26; ELVR = 60). Compared to controls, LVRS patients had a higher rate of postoperative ECMO (15.4 vs. 3.9%; p = 0.006), whereas ELVR patients suffered more often from wound infections (8.9% vs. 2.5%; p = 0.018). Perioperative outcome, duration of ventilation, ICU stay, and hospital stay were comparable between groups. Bacterial colonization of the airway differed significantly between both LVR groups and controls in pre- and post-LuTX cultures. Survival was not impacted (1-/3-/5-year survival for LVRS: 92.3%/85.7%/77.1%; controls: 91.3%/82.4%/76.3%; p = 0.58 | ELVR: 93.1%/91%/91%; controls 91.2%/81.7%/75.3%; p = 0.17). Conclusion: Lung volume reduction does not impact short and long-time survival after bilateral LuTX. Due to differences in airway colonization after LVR, caution to prevent infectious complications is warranted.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Celia Hedderich
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany
| | - Panja M Boehm
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stefan Schwarz
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Markus Kamler
- West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Peter Jaksch
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
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Caviezel C, Froehlich T, Schneiter D, Muehlematter U, Frauenfelder T, Guglielmetti LC, Opitz I, Weder W. Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering. ERJ Open Res 2020; 6:00305-2020. [PMID: 32963992 PMCID: PMC7487346 DOI: 10.1183/23120541.00305-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022] Open
Abstract
Background The key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology. Methods A real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months. Results Five patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively. Conclusion We demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures. New, user-friendly software with 3D CT-rendered images can be used for planning personalised remodelling of hyperinflated lungs using LVRShttps://bit.ly/3fbICn2
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Affiliation(s)
- Claudio Caviezel
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tamara Froehlich
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Urs Muehlematter
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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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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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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