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Everaerts S, Vandervelde CM, Shah P, Slebos DJ, Ceulemans LJ. Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema. Eur Respir Rev 2023; 32:230004. [PMID: 38123230 PMCID: PMC10731473 DOI: 10.1183/16000617.0004-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/17/2023] [Indexed: 12/23/2023] Open
Abstract
COPD is a highly prevalent, chronic and irreversible obstructive airway disease without curative treatment. Standard therapeutic strategies, both non-pharmacological and pharmacological, have only limited effects on lung function parameters of patients with severe disease. Despite optimal pharmacological treatment, many patients with severe COPD still have a high burden of dyspnoea and a poor quality of life. If these patients have severe lung emphysema, with hyperinflation as the driver of symptoms and exercise intolerance, lung volume reduction may be an effective treatment with a significant impact on lung function, exercise capacity and quality of life. Currently, different lung volume reduction approaches, both surgical and bronchoscopic, have shown encouraging results and have been implemented in COPD treatment recommendations. Nevertheless, choosing the optimal lung volume reduction strategy for an individual patient remains challenging. Moreover, there is still room for improving durability of effect and safety in all available procedures. Ongoing and innovative research is essential to push this field forwards. This review provides an overview of results and limitations of the current lung volume reduction options for patients with severe lung emphysema and hyperinflation.
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Affiliation(s)
- Stephanie Everaerts
- Department of Pulmonary Diseases, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Christelle M. Vandervelde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pallav Shah
- Department of Pulmonology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Pulmonology, Chelsea and Westminster Hospital, London, UK
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Both authors contributed equally
| | - Laurens J. Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Both authors contributed equally
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Agusti A, Ambrosino N, Blackstock F, Bourbeau J, Casaburi R, Celli B, Crouch R, Negro RD, Dreher M, Garvey C, Gerardi D, Goldstein R, Hanania N, Holland AE, Kaur A, Lareau S, Lindenauer PK, Mannino D, Make B, Maltais F, Marciniuk JD, Meek P, Morgan M, Pepin JL, Reardon JZ, Rochester C, Singh S, Spruit MA, Steiner MC, Troosters T, Vitacca M, Clini E, Jardim J, Nici L, Raskin J, ZuWallack R. COPD: Providing the right treatment for the right patient at the right time. Respir Med 2023; 207:107041. [PMID: 36610384 DOI: 10.1016/j.rmed.2022.107041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.
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Affiliation(s)
- Alvar Agusti
- Clinic Barcelona Hospital University, Barcelona, Spain.
| | | | | | - Jean Bourbeau
- Department of Medicine, Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, CA, USA.
| | | | | | | | - Roberto Dal Negro
- National Centre for Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy.
| | - Michael Dreher
- Clinic of Cardiology, Angiology, Pneumology and Intensive Medicine, University Hospital Aachen, Aachen, 52074, DE, USA.
| | | | | | - Roger Goldstein
- Respiratory Rehabilitation Service, West Park Health Care Centre, Toronto, Ontario, CA, USA.
| | | | - Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Antarpreet Kaur
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA; University of Colorado School of Nursing, Aurora, CO, USA.
| | - Suzanne Lareau
- University of Colorado School of Nursing, Aurora, CO, USA.
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
| | | | - Barry Make
- National Jewish Health, Denver, CO, USA.
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, CA, USA.
| | - Jeffrey D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, CA, USA.
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA.
| | - Mike Morgan
- Dept of Respiratory Medicine, University Hospitals of Leicester, UK.
| | - Jean-Louis Pepin
- CHU de Grenoble - Clin Univ. de physiologie, sommeil et exercice, Grenoble, France.
| | - Jane Z Reardon
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA.
| | | | - Sally Singh
- Department of Respiratory Diseases, University of Leicester, UK.
| | | | - Michael C Steiner
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre, Professor, University of Leicester, UK.
| | - Thierry Troosters
- Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven: Leuven, Vlaanderen, Belgium.
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, ICS S. Maugeri Care and Research Institutes, IRCCS Pavia, Italy.
| | - Enico Clini
- University of Modena and Reggio Emilia, Italy.
| | - Jose Jardim
- Federal University of Sao Paulo Paulista, Brazil.
| | - Linda Nici
- nBrown University School of Medicine, USA.
| | | | - Richard ZuWallack
- Section of Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
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Lashari BH, Criner GJ. Advances in Surgical and Mechanical Management of Chronic Obstructive Pulmonary Disease. Med Clin North Am 2022; 106:1013-1025. [PMID: 36280329 DOI: 10.1016/j.mcna.2022.07.006] [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: 10/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality in the United States, behind cardiovascular and malignant disorders. As the understanding of the pathogenesis has evolved, it led to targeting mechanical aspects of the disease to improve patient symptoms and quality of life. Modern management of COPD offers a variety of mechanical and surgical treatments for patients with advanced disease who do not achieve benefit from medical therapy alone. These treatments include therapies aimed at lung volume reduction, through surgical or bronchoscopic techniques. While these techniques are established and have proven benefit, others are still under development. Herein we discuss these techniques, aimed at improving clinician recognition of patients that may benefit from these interventions.
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Affiliation(s)
- Bilal H Lashari
- Department of Thoracic Medicine and Surgery, Temple Lung Center, Temple University Hospital, 7 Parkinson Pavilion, 3401 North Broad Street, Philadelphia 19140, USA.
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Temple Lung Center, Temple University Hospital, 7 Parkinson Pavilion, 3401 North Broad Street, Philadelphia 19140, USA
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[Interventional bronchoscopy-an overview]. PNEUMOLOGE 2021; 18:405-418. [PMID: 34642585 PMCID: PMC8495438 DOI: 10.1007/s10405-021-00413-1] [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] [Accepted: 08/25/2021] [Indexed: 12/02/2022]
Abstract
Die Bronchoskopie stellt neben der Lungenfunktion und der radiologischen Bildgebung das wichtigste Diagnostikum bei Patienten mit Atemwegs- und Lungenerkrankungen dar. Aufgrund des kombinierten Einsatzes flexibler und starrer Bronchoskope kommt sie heutzutage aber auch zunehmend als endoskopisches Therapieverfahren bei pulmonalen Erkrankungen in Frage. Bei thorakalen Tumoren kann die interventionelle Bronchoskopie sowohl in palliativer als auch kurativer Intention zum Einsatz kommen. Neben der bronchoskopischen Tumorbehandlung rückten in den letzten Jahren zunehmend die Techniken der endoskopischen Lungenvolumenreduktion in den Fokus. Darüber hinaus bieten sich Therapiemöglichkeiten für Asthma und chronische Bronchitis sowie bei Atemwegsstenosen und -fisteln.
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Verga SR, Criner GJ. Device profile of the Zephyr endobronchial valve in heterogenous emphysema: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:823-832. [PMID: 34314290 DOI: 10.1080/17434440.2021.1957831] [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: 10/20/2022]
Abstract
INTRODUCTION Emphysema affects millions of people; the underlying pathophysiology is hyperinflation due to destruction of lung parenchyma. The mainstay of treatment is medical therapy however there are two surgical treatment strategies approved by the FDA to reduce lung hyperinflation. First being lung volume reduction surgery (LVRS), which carries higher risk of mortality versus bronchoscopic lung volume reduction (BLVR). BLVR has reduced peri-operative morbidity without compromising improvement in post-bronchodilator forced expiratory volume 1s (FEV1) and patient-reported outcomes. The added benefit of BLVR is that older adults who have end-stage emphysema who otherwise would not be appropriate surgical candidates for LVRS or transplant have an alternative treatment option. AREAS COVERED This is a review paper focusing on Zephyr® endobronchial valves (EBV). Specifically, clinical outcomes of major trials, selection criteria, valve/deployment catheter features, description of procedure, discussing the Chartis™ Pulmonary Assessment System and StratX report, management of complications and discussing next steps in protocolizing post-EBV care. EXPERT OPINION The expert opinion section focuses on outcomes from the LIBERATE Trial and 1-yr post-hoc analysis. Further 5-year follow-up post Zephyr® EBV placement along with protocolization post-EBV placement are needed to minimize adverse events and/or be able to manage, especially with high risk of pneumothorax (PTX).
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Affiliation(s)
- Steven R Verga
- 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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Pompeo E, Elkhouly A, Rogliani P, Dauri M, Peer M, Sergiacomi G, Sorge R. Quasilobar minimalist lung volume reduction surgery. Eur J Cardiothorac Surg 2021; 60:598-606. [PMID: 33860323 DOI: 10.1093/ejcts/ezab174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. METHODS Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. RESULTS Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). CONCLUSIONS QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.
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Affiliation(s)
- Eugenio Pompeo
- Department of Thoracic Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed Elkhouly
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Paola Rogliani
- Department of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Dauri
- Department of Anesthesia and Intensive Care, Tor Vergata University of Rome, Rome, Italy
| | - Michael Peer
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv, Israel
| | | | - Roberto Sorge
- Department of Biostatistics, Tor Vergata University of Rome, Rome, Italy
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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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Valipour A, Shah PL, Pison C, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner J, Abele C, Hartman JE, Slebos DJ. Safety and Dose Study of Targeted Lung Denervation in Moderate/Severe COPD Patients. Respiration 2019; 98:329-339. [PMID: 31220851 PMCID: PMC6878750 DOI: 10.1159/000500463] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Targeted lung denervation (TLD) is a novel bronchoscopic treatment for the disruption of parasympathetic innervation of the lungs. OBJECTIVES To assess safety, feasibility, and dosing of TLD in patients with moderate to severe COPD using a novel device design. METHODS Thirty patients with COPD (forced expiratory volume in 1 s 30-60%) were 1:1 randomized in a double-blinded fashion to receive TLD with either 29 or 32 W. Primary endpoint was the rate of TLD-associated adverse airway effects that required treatment through 3 months. Assessments of lung function, quality of life, dyspnea, and exercise capacity were performed at baseline and 1-year follow-up. An additional 16 patients were enrolled in an open-label confirmation phase study to confirm safety improvements after procedural enhancements following gastrointestinal adverse events during the randomized part of the trial. RESULTS Procedural success, defined as device success without an in-hospital serious adverse event, was 96.7% (29/30). The rate of TLD-associated adverse airway effects requiring intervention was 3/15 in the 32 W versus 1/15 in the 29 W group, p = 0.6. Five patients early in the randomized phase experienced serious gastric events. The study was stopped and procedural changes made that reduced both gastrointestinal and airway events in the subsequent phase of the randomized trial and follow-up confirmation study. Improvements in lung function and quality of life were observed compared to baseline values for both doses but were not statistically different. CONCLUSIONS The results demonstrate acceptable safety and feasibility of TLD in patients with COPD, with improvements in adverse event rates after procedural enhancements.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, InsermU1055, Université Grenoble Alpes, Grenoble, France
| | - Vincent Ninane
- CHU Saint-Pierre, Université libre de Bruxelles, Bruxelles, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Perez
- CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019, CNRS UMR 8204 Univ Lille Nord de France, Lille, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, INSERM UMRS 1250, Service de Pneumologie, Reims, France
| | - Justin Garner
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christine Abele
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Jorine E Hartman
- 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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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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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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Endobronchial coils in treatment of advanced emphysema: A single center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:57-62. [PMID: 32082828 DOI: 10.5606/tgkdc.dergisi.2019.16893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to present our experience with endobronchial coils in patients who underwent endobronchial lung volume reduction due to advanced emphysema. Methods The study included 46 patients (45 males, 1 female; mean age 61.7±8 years; range, 43 to 80 years) who underwent endobronchial lung volume reduction with endobronchial coils for advanced emphysema. Patients" age, gender, pulmonary function tests, post-treatment morbidity, mortality, pre- and post-treatment (6 months) six-minute walking distance, modified Medical Research Council dyspnea scores, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores were recorded. Results Patients had an average of 65 pack/year smoking history. An average of 11 (range, 9-15) coils were placed per lobe (right upper lobe=35, left upper lobe=19, right lower lobe=2, left lower lobe=4). Mean follow-up duration was 12.6 months (±5.6 months). Post-treatment forced expiratory volume in one second, residual volume and six-minute walking distance values were improved with statistical significance. Also, significant improvement was seen in quality of life, quantified by modified Medical Research Council, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores. While no immediate major postoperative complications occurred, three patients developed chronic obstructive pulmonary disease exacerbation, two developed pneumonia, and one developed recurrence of previous neurologic disorder within 30 days. Conclusion Endobronchial coil administration provides lower morbidity and mortality compared to lung volume reduction surgery as well as significant improvement in pulmonary functions and quality of life in selected patients with advanced emphysema.
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Gulsen A. Importance of bronchoscopic lung volume reduction coil therapy in potential candidates for lung transplantation. Biosci Trends 2018; 12:395-402. [PMID: 30158333 DOI: 10.5582/bst.2018.01134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscopic lung volume reduction (BLVR) coil treatment is a alternative and promising treatment modality for selected severe emphysema patients. The main indication of this treatment modality is a forced expiration volume in one second (FEV1) of 15-45% and a residual volume (RV) > 175%. The aim of this study was to investigate the efficacy of BLVR coil therapy in patients with end-stage emphysema who were potential candidates for lung transplantation and had FEV1 values less than 25%. Twenty-one patients who underwent bilateral BLVR coil therapy between September 2013 and May 2015 were retrospectively reviewed. We compared the changes in clinical and laboratory parameters at the baseline and 12 months after the treatment. Twelve months after the bilateral BLVR coil treatment, we observed an average increase in FEV1 (110 mL and 4.6%), a decrease in residual volume (660 mL and 33%), and an increase in 6-minute walk tests (67 m). The most common complications were chronic obstructive pulmonary disease exacerbation (47.6%) and pneumonia (23.8%). All patients tolerated the general anesthesia and procedure very well. BLVR coil therapy is safe and effective in patients with end-stage emphysema, who are potential candidates for lung transplantation within a short to medium period. The complication rates of this treatment were not different from those of the other coil treatments, and the improvements in the clinical parameters after the treatment resulted in gaining time for lung transplantation. Future research for evaluating the long-term efficacy of BLVR coil therapy in these patients is essential.
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Affiliation(s)
- Askin Gulsen
- Department of Pneumology, School of Medicine, Sifa University.,Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research, Center North (ARCN), Member of the German Center for Lung Research
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Kontogianni K, Russell K, Eberhardt R, Schuhmann M, Heussel CP, Wood S, Herth FJ, Gompelmann D. Clinical and quantitative computed tomography predictors of response to endobronchial lung volume reduction therapy using coils. Int J Chron Obstruct Pulmon Dis 2018; 13:2215-2223. [PMID: 30050294 PMCID: PMC6055902 DOI: 10.2147/copd.s159355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives Bronchoscopic lung volume reduction using coils (LVRC) is a well-known treatment option for severe emphysema. The purpose of this study was to identify quantitative computed tomography (QCT) and clinical parameters associated with positive treatment outcome. Patients and methods The CT scans, pulmonary function tests (PFT), and 6-minute walk test (6-MWT) data were collected from 72 patients with advanced emphysema prior to and at 3 months after LVRC treatment. The procedure involved placing 10 coils unilaterally. Various QCT parameters were derived using Apollo imaging software (VIDA). Independent predictors of clinically relevant outcome (Δ6-MWT ≥ 26 m, ΔFEV1 ≥ 12%, ΔRV ≥ 10%) were identified through stepwise linear regression analysis. Results The response outcome for Δ6-MWT, for ΔFEV1 and for ΔRV was met by 55%, 32% and 42%, respectively. For Δ6-MWT ≥ 26 m a lower baseline 6-MWT (p = 0.0003) and a larger standard deviation (SD) of low attenuation cluster (LAC) sizes in peripheral regions of treated lung (p = 0.0037) were significantly associated with positive outcome. For ΔFEV1 ≥ 12%, lower baseline FEV1 (p = 0.02) and larger median LAC sizes in the central regions of treated lobe (p = 0.0018) were significant predictors of good response. For ΔRV ≥ 10% a greater baseline TLC (p = 0.0014) and a larger SD of LAC sizes in peripheral regions of treated lung (p = 0.007) tended to respond better. Conclusion Patients with lower FEV1 and 6-MWT, with higher TLC and specific QCT characteristics responded more positively to LVRC treatment, suggesting a more targeted CT-based approach to patient selection could lead to greater efficacy in treatment response.
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Affiliation(s)
- Konstantina Kontogianni
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | | | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Maren Schuhmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany, .,Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Heidelberg, Germany
| | | | - Felix Jf Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Daniela Gompelmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
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14
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Slebos DJ, Ten Hacken NH, Hetzel M, Herth FJF, Shah PL. Endobronchial Coils for Endoscopic Lung Volume Reduction: Best Practice Recommendations from an Expert Panel. Respiration 2018; 96:1-11. [PMID: 29991060 DOI: 10.1159/000490193] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/30/2022] Open
Abstract
Endobronchial coils are an additional treatment option for lung volume reduction in patients with severe emphysema. Patient selection should be focused on patients with severe emphysema on optimal medical therapy and with evidence of severe hyperinflation. The technique is suitable in a broad range of patients with emphysema; however, patients with paraseptal emphysema, large focal (giant) bullae, significant co-morbidity and airway-predominant disease should be avoided. Treatment involves placing between 10 and 14 coils by bronchoscopy in the selected treatment lobe, with 2 lobes being treated sequentially. Lobe selection for treatment should be based on quantitative computed tomography, and the lobes with the greatest destruction should be targeted (excluding the right middle lobe). The treatment results in an improvement in pulmonary function, exercise performance and quality of life, particularly in patients with severe hyperinflation (residual volume > 200% predicted) and upper-lobe heterogeneous emphysema, but will also be of benefit in lower-lobe predominant and homogeneous emphysema. Finally, it has an acceptable safety profile, although special attention has to be paid to coil-associated opacity which is an inflammatory response that occurs in some patients treated with endobronchial coils.
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Affiliation(s)
- Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Nick H Ten Hacken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | | | - Felix J F Herth
- Thoraxklinik and Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
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15
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Abstract
Emphysema causes significant morbidity and mortality, incurring both financial and psychosocial costs. Alternatives to medical therapy and surgical lung volume reduction surgery (LVRS) have increased interest in bronchoscopic techniques. Bronchoscopic lung volume reduction (BLVR) is still in its infancy and additional trials and follow-up are critical. However, several new randomized clinical trials (RCTs) have demonstrated improvement in lung function, quality of life and exercise capacity in select patients receiving endobronchial valves and coil therapy. This article highlights recent data regarding bronchoscopic treatment of emphysema.
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Affiliation(s)
- Anuradha Ramaswamy
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan Puchalski
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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16
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Aggelou K, Siafakas N. Medical lung volume reduction for severe emphysema: A review. Respir Med 2017; 131:141-147. [DOI: 10.1016/j.rmed.2017.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/27/2022]
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17
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Debray MP, Marceau A, Dombret MC, Bunel V, Leroy S, Deslée G, Mal H. Bronchiectasis Complicating Lung Volume Reduction Coil Treatment. Chest 2017; 152:e57-e60. [DOI: 10.1016/j.chest.2017.04.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 10/18/2022] Open
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