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路 慧, 李 振, 余 耀, 李 国, 梁 婷, 张 华. [Efficacy and Safety of Medical Thoracoscopic Bulla Volume Reduction in the Treatment of Chronic Obstructive Pulmonary Disease Combined With Giant Emphysematous Bullae]. Sichuan Da Xue Xue Bao Yi Xue Ban 2024; 55:403-410. [PMID: 38645849 PMCID: PMC11026879 DOI: 10.12182/20240360604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 04/23/2024]
Abstract
Objective To explore the efficacy and safety of medical thoracoscopic bulla volume reduction for the treatment of chronic obstructive pulmonary disease (COPD) combined with giant emphysematous bullae (GEB). Methods A total of 66 patients with COPD combined with GEB were enrolled in the study. All the subjects received treatment at Zhengzhou Central Hospital affiliated with Zhengzhou University between March 2021 and December 2022. The subjects were divided into two groups, a medical thoracoscope group consisting of 30 cases treated with medical thoracoscopic bulla volume reduction and a surgical thoracoscope group consisting of 36 cases treated by video-assisted thoracoscopic surgery. All patients were followed up before discharge and 3 months and 6 months after discharge. The preoperative and postoperative levels of the pulmonary function, 6-minute walk distance (6MWD), and St. George's Respiratory Questionnaire (SGRQ) scores and differences in postoperative complications were compared between the two groups. The operative duration, postoperative length-of-stay, and surgical costs and hospitalization bills, and the maximum visual analog scale (VAS) pain scores at 24 h after the procedure were assessed. Results The baseline data of the two groups were comparable, showing no statistically significant difference. The forced expiratory volume in 1 second (FEV1) 6 months after the procedures improved in both the medical thoracoscopy group ([0.78±0.29] L vs. [1.02±0.31] L, P<0.001) and the surgical thoracoscopy group ([0.80±0.21] L vs. [1.03±0.23] L, P<0.001) compared to that before the procedures. Improvements to a certain degree in 6MWT and SGRQ scores were also observed in the two groups at 3 months and 6 months after the procedures (P<0.05). In addition, no statistically significant difference in these indexes was observed during the follow-up period of the patients in the two groups. There was no significant difference in operating time between the two groups. The medical thoracoscopy group had shorter postoperative length-of-stay ([7.3±2.6] d) and 24-hour postoperative VAS pain scores (3.0 [2.0, 3.3]) than the surgical thoracoscopic group did ([10.4±4.3] d and 4.5 [3.0, 5.0], respectively), with the differences being statistically significant (P<0.05). Surgical cost and total hospitalization bills were lower in the medical thoracoscopy group than those in the surgical thoracoscopy group (P<0.05). The complication rate in the medical thoracoscopy group was lower than that in the surgical thoracoscopy group (46.7% vs. 52.8%), but the difference was not statistically significant. Conclusion Medical thoracoscopic reduction of bulla volume can significantly improve the pulmonary function, quality of life, and exercise tolerance of patients with COPD combined with GEB, and it can reduce postoperative short-term pain and shorten postoperative length-of-stay. The procedure has the advantages of minimal invasiveness, quick recovery, and low costs. Hence extensive clinical application is warranted.
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Affiliation(s)
- 慧 路
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
- 郑州大学附属郑州中心医院 呼吸与危重症医学科 (郑州 450000)Department of Respiratory and Critical Care Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
| | - 振华 李
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
| | - 耀华 余
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
| | - 国燕 李
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
| | - 婷婷 梁
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
| | - 华 张
- 郑州大学 (郑州 450000)Zhengzhou University, Zhengzhou 450000, China
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Brock JM, Böhmker F, Schuster PU, Eberhardt R, Gompelmann D, Kontogianni K, Dittrich S, Benjamin N, Herth F. Endobronchial lung volume reduction with valves reduces exacerbations in severe emphysema patients. Respir Med 2023; 218:107399. [PMID: 37673413 DOI: 10.1016/j.rmed.2023.107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Exacerbations drive the progression of chronic obstructive pulmonary disease (COPD). Endoscopic lung volume reduction (ELVR) with valves is an established treatment option for patients with severe emphysema. Post-interventional exacerbations are observed in 8-17% of cases. Whether the exacerbation rate changes in the medium term after ELVR, is not known. METHODS This is a single-center retrospective analysis of severe emphysema patients with endobronchial valve implantation. The number of exacerbations before and after ELVR was compared, including lung function parameters, exercise capacity and degree of lung volume reduction. The primary endpoint of the study was the number of exacerbations one year after ELVR compared to one year before ELVR. RESULTS 129 patients (mean age 64.1 ± 7.7 years, 57% female, mean FEV1 0.8 ± 0.2 l, mean RV 243.4 ± 54.9 %) with ELVR in the years 2016-2019 and complete exacerbation history were analyzed. Patients experienced a mean of 2.5 ± 2.2 moderate and severe exacerbations in the year before ELVR. The number of exacerbations decreased significantly to 1.8 ± 2.2 exacerbations in the first year after ELVR (p = 0.009). The decrease in exacerbation rate was associated with the development of complete lobar atelectasis (r = 0.228. p = 0.009). Accordingly, in 41 patients with complete lobar atelectasis, the decrease in exacerbation rate was higher from 2.8 ± 2.0 to 1.4 ± 1.8 exacerbations (p < 0.001). CONCLUSIONS ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved.
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Affiliation(s)
- Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Felix Böhmker
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | | | - Ralf Eberhardt
- Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Konstantina Kontogianni
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Susanne Dittrich
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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Zhi L, Liao L, Wu Z, Wang T, Ye Y, Li H, Lin L, Qi JC, Zhang L. Impact of bronchoscopic thermal vapor ablation on lung volume reduction in patients with emphysema: a meta-analysis. BMC Pulm Med 2023; 23:405. [PMID: 37884912 PMCID: PMC10601098 DOI: 10.1186/s12890-023-02689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (LVR) could significantly improve pulmonary function and quality of life in patients with emphysema. We aimed to assess the efficacy and safety of bronchoscopic thermal vapor ablation (BTVA) on LVR in patients with emphysema at different stage. METHODS A systematic search of database including PubMed, Embase and Cochrane library was conducted to determine all the studies about bronchoscopic thermal vapor ablation published through Dec 1, 2022. Related searching terms were "lung volume reduction", "bronchoscopic thermal vapor ablation", "bronchial thermal vapor ablation" "BTVA" and "emphysema", "efficacy" and"safety". We used standardized mean difference (SMD) to analyze the summary estimates for BTVA therapy. RESULTS We retrieved 30 records through database search, and 4 trials were selected for meta-analysis, including 112 patients with emphysema. Meta-analysis of the pooled effect showed that levels of forced expiratory volume in 1 s (FEV1), residual volume (RV), total lung capacity (TLC), 6-min walk distance (6MWD) and St George's Respiratory Questionnaire (SGRQ) were significantly improved in patients with emphysema following BTVA treatment between 6 months vs. baseline. Additionally, no significant changes in FEV1, RV, TLC and SGRQ occurred from 3 to 6 months of follow-up except for 6MWD. The magnitude of benefit was higher at 3 months compared to 6 months. The most common complications at 6 months were treatment-related chronic obstructive pulmonary disease (COPD) exacerbations (RR: 12.49; 95% CI: 3.06 to 50.99; p < 0.001) and pneumonia (RR: 9.49; 95% CI: 2.27 to 39.69; p < 0.001). CONCLUSIONS Our meta-analysis provided clinically relevant information about the impact and safety of BTVA on predominantly upper lobe emphysema. Particularly, short-term significant improvement of lung function and quality of life occurred especially within the initial 3 months. Further large-scale, well-designed long-term interventional investigations are needed to clarify this issue.
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Affiliation(s)
- Lijia Zhi
- Department of Intensive Care Unit, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Rd, Jinniu District, Chengdu, Sichuan Province, 610075, People's Republic of China
| | - Liping Liao
- Department of Ultrasonic Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China.
| | - Zhi Wu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China
| | - Tiezhu Wang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China
| | - Yuming Ye
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China
| | - Li Lin
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China
| | - Jia-Chao Qi
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China.
| | - Liangji Zhang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng, Zhangzhou, Fujian Province, 363000, People's Republic of China.
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Bakker JT, Klooster K, Wisselink HJ, Pelgrim GJ, Vliegenthart R, Slebos DJ. Effect of Chest Computed Tomography Kernel Use on Emphysema Score in Severe Chronic Obstructive Pulmonary Disease Patients Evaluated for Lung Volume Reduction. Respiration 2023; 102:164-172. [PMID: 36543148 DOI: 10.1159/000528628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chest computed tomography (CT) emphysema quantification is a vital diagnostic tool in patient evaluation for bronchoscopic lung volume reduction (BLVR). Smooth kernels for CT image reconstruction are generally recommended for quantitative analyses. This recommendation is not always followed, which may affect quantification of emphysema extent and eventually, treatment decisions. OBJECTIVE The main goal is to demonstrate the influence of CT reconstruction kernels on emphysema quantification in patients with severe COPD, considered for BLVR. METHODS Chest CT scans were acquired with one multi-detector CT system and reconstructed using three different kernels: smooth, medium smooth, and sharp. Other parameters were kept constant. Emphysema scores (ESs), meaning the percentage of voxels below -950 Hounsfield units, were calculated and compared to the smooth reference kernel using paired t tests. Bland-Altman plots were made to assess the biases and limits of agreement between kernels. RESULTS Ninety-eight COPD patient CT scans were analyzed. The sharp kernel had a systematic bias of 6.2% and limits of agreement of 16.6% to -4.2% compared to the smooth kernel. The medium smooth kernel had a systematic bias of 5.7% and limits of agreement of 9.2% and 2.2% compared to the smooth kernel. The ES differed, for a single patient, up to 18% for different kernels. CONCLUSIONS Chest CT kernel reconstruction can lead to a significant difference in emphysema severity quantification. This may cause invalid treatment selection in COPD patients evaluated for BLVR. Standardization of a smooth CT kernel setting and/or normalization to a standard kernel is strongly recommended.
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Affiliation(s)
- Jens T Bakker
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrik Joost Wisselink
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Saccomanno J, Hübner RH, Witzenrath M, Doellinger F, Dittrich AS, Kontogianni K, Herth F, Brock JM. Bronchoscopic Measurement of Collateral Ventilation: State of the Art. Respiration 2023; 102:296-307. [PMID: 36731440 DOI: 10.1159/000528419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Endoscopic lung volume reduction procedure with valves is a well-studied treatment option for advanced lung emphysema to target lung hyperinflation in carefully selected patients with COPD. Before valve implantation, collateral ventilation (CV) of the target lobe needs to be assessed to obtain an optimal treatment effect. The analysis of CV according to current standards occurs via an in vivo assessment with the Chartis®system (PulmonX Inc., Redwood City, CA, USA) and a computed tomography (CT) scan of the thorax with interlobar fissure analysis. The focus of this review is to provide detailed information about the Chartis®procedure and interpretation of Chartis® phenotypes. As a main tool in the assessment of CV and being a safe procedure, the Chartis® assessment should be performed by default to confirm interlobar fissure analysis in most emphysema patients. Based on the obtained results, lung volume reduction therapy options should be discussed in an interdisciplinary emphysema conference.
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Affiliation(s)
- Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Doellinger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Susanne Dittrich
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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Buttery SC, Williams PJ, Brighton LJ, Batista C, Dewar A, Hogg L, Ingram K, Korff G, Koulopoulou M, Lammin H, Maddocks M, McDonnell L, Mehta B, Meyrick V, Pritchard L, Smith O, Trivedi P, Lawson RA, Hopkinson NS. Development and implementation of the lung volume reduction pulmonary rehabilitation tool to identify eligibility for lung volume reduction in people with chronic obstructive pulmonary disease during pulmonary rehabilitation. Chron Respir Dis 2023; 20:14799731231198863. [PMID: 37658799 PMCID: PMC10475255 DOI: 10.1177/14799731231198863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Completion of pulmonary rehabilitation is recognised in chronic obstructive pulmonary disease (COPD) guidelines as a key opportunity to consider systematically whether a respiratory review to assess potential suitability for a lung volume reduction (LVR) procedure might be appropriate. We describe the development of a simple decision-support tool (the LVR-PR tool) to aid clinicians working in pulmonary rehabilitation, to operationalise this process. METHODS We took an iterative mixed methods approach, which was partnership-based and involved an initial consensus survey, focus groups and an observational study cohort at multiple pulmonary rehabilitation centres. RESULTS Diagnosis (97%), exercise capacity (84%), breathlessness (78%) and co-morbidities (76%) were acknowledged to be essential items for assessing basic LVR eligibility. Collating prior investigations and assessing patient understanding were considered useful but not essential. Clinician concerns included; streamlining the tool; access to clinical information and investigations; and care needed around introducing LVR therapies to patients in a PR setting. Access to clearer information about LVR procedures, the clinician's role in considering eligibility and how educational resources should be delivered were identified as important themes from patient group discussions. The LVR-PR tool was considered to be feasible and valid for implementation in a variety of PR services across the UK subject to the provision of appropriate health professional training. Clinicians working in specialist LVR centres across the UK who were not otherwise involved in the development process confirmed the tool's validity using the content validity index (CVI). INTERPRETATION The LVR-PR tool appears to be an acceptable tool that can be feasibly implemented in PR services subject to good quality educational resources for both patients and healthcare professionals.
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Affiliation(s)
- Sara C Buttery
- NHLI, Airways Disease, Faculty of Medicine, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Parris J Williams
- NHLI, Airways Disease, Faculty of Medicine, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Lisa J Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Craig Batista
- Department of Respiratory Medicine, Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Amy Dewar
- Department of Respiratory Medicine, Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Lauren Hogg
- Department of Physiotherapy, Guys and St Thomas' Hospital NHS Foundation Trust, London UK
| | - Karen Ingram
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Gemma Korff
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Maria Koulopoulou
- Department of Intergrated Respiratory Care, King’s College Hospital, London, UK
| | - Helen Lammin
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Lynn McDonnell
- Department of Physiotherapy, Guys and St Thomas' Hospital NHS Foundation Trust, London UK
| | - Bhavin Mehta
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Victoria Meyrick
- Department of Intergrated Respiratory Care, King’s College Hospital, London, UK
| | - Lisa Pritchard
- Department of Physiotherapy, Guys and St Thomas' Hospital NHS Foundation Trust, London UK
| | - Oliver Smith
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Puja Trivedi
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Rod A Lawson
- Respiratory and General Internal Medicine, Sheffield Teachning Hospitals Foundation NHS Trust, Sheffield, UK
| | - Nicholas S Hopkinson
- NHLI, Airways Disease, Faculty of Medicine, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals Clinical Group of Guys and St Thomas’ NHS Foundation Trust, London, UK
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Klooster K, Hartman JE, Koster TD, Slebos DJ, van Dijk M. Prevalence and Impact of COVID-19 among Severe COPD Patients post Bronchoscopic Lung Volume Reduction Treatment with Endobronchial Valves. Respiration 2023; 102:203-206. [PMID: 36529120 PMCID: PMC9843730 DOI: 10.1159/000528610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has a great impact on numberless aspects of our society. In our bronchoscopic lung volume reduction interventional program, we work with severe COPD patients on a daily basis. OBJECTIVES We were interested in the prevalence and outcome of COVID-19, impact of the pandemic on daily life, and the vaccination coverage in our severe COPD patients who have been treated with one-way endobronchial valves. METHOD A questionnaire, which consisted of questions related to the infection rate, treatment, and outcome of COVID-19 infections; feelings of anxiety related to the pandemic; adherence to preventive measures; and willingness to be vaccinated; was sent to our patients in June 2021. RESULTS The questionnaire was sent to 215 patients, and the response rate was 100%. The vaccination rate was 97% in our surveyed population. The majority of patients (63%) indicated that they were quite or very anxious to get infected with COVID-19. Twenty-five (11.5%) patients were diagnosed with COVID-19, with none of these patients having been vaccinated at the time of infection. The infection rate reported in this study is comparable to that of the general Dutch population. However, the hospital admission rate and mortality rates are higher. CONCLUSIONS Our results show that the SARS-CoV-2 infection rate in severe COPD patients treated with endobronchial valves was comparable with the general population; however, the hospital admission and mortality rates were worse.
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Li A, Lee P. Which Endoscopic Procedure to Use and in What Patient? Valves, Coils, Foam, and Heat in COPD and Asthma. Pulm Ther 2022; 9:49-69. [PMID: 36534323 PMCID: PMC9931990 DOI: 10.1007/s41030-022-00208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
Despite the latest developments in therapeutic agents targeting airway endotypes, a significant proportion of patients with asthma and chronic obstructive pulmonary disease (COPD) remain symptomatic. Endoscopic therapies have a complementary role in the management of these airway diseases. The sustained efficacy of bronchial thermoplasty (BT) among patients with asthma over 10 years has been encouraging, as it has been shown to improve symptom control and reduce hospital admissions and exacerbations. Studies suggest that BT helps ameliorate airway inflammation and reduce airway smooth muscle thickness. While studies suggest that it is as effective as biologic agents, its role in the management of severe asthma has yet to be clearly defined and GINA 2022 still suggests limiting its use to patients with characteristics of the various populations studied. Conversely, bronchoscopic lung volume reduction has shown promise among patients with advanced COPD. Rigorous patient selection is important. Patients with minimal collateral ventilation (CV) and higher heterogeneity index have shown to benefit the most from endobronchial valve (EBV) therapy. For those with ongoing CV, endobronchial coils would be more appropriate. Both therapeutic modalities have demonstrated improved quality of life, effort tolerance, and lung function indices among appropriately selected patients. The emerging evidence suggests that endoscopic procedures among airway disease still have a substantial role to play despite the development of new therapeutic options.
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Affiliation(s)
- Andrew Li
- Respiratory and Critical Care Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Respiratory Service, Department of Medicine, Woodlands Health, Singapore, Singapore.
| | - Pyng Lee
- Respiratory and Critical Care Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore ,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Döllinger F, Elsner A, Hübner RH. [Computed tomographic imaging in chronic obstructive pulmonary disease : What pulmonologists and thoracic surgeons want to know]. Radiologie (Heidelb) 2022; 62:747-757. [PMID: 35819467 DOI: 10.1007/s00117-022-01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) begins with chronic inflammation of the bronchial system and leads to the development of emphysema in many patients. COPD patients are characterized by reduced performance, dyspnea in the context of an obstructive respiratory disorder and increased susceptibility to infections. COPD has a major impact on public health, as it is very common and many patients die from it. The most important preventable cause of COPD is tobacco smoke inhalation, which is why consistent smoking cessation is the most important component of any COPD treatment. There is no causal therapy, but in severely symptomatic patients with advanced emphysema, respiratory mechanics can be improved by lung volume reduction if all conservative treatment options have been exhausted. Diagnostic imaging is of great importance in the care of COPD patients. This article summarizes which indications warrant the performance of computed tomography (CT) and what we should pay special attention to during image analysis in order to provide optimal advice to our clinical partners.
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Affiliation(s)
- Felix Döllinger
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Aron Elsner
- Chirurgische Klinik, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ralf-Harto Hübner
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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10
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Cosío BG, Hernández C, Chiner E, Gimeno-Santos E, Pleguezuelos E, Seijas N, Rigau D, López-Campos JL, Soler-Cataluña JJ, Calle M, Miravitlles M, Casanova C. Spanish COPD Guidelines (GesEPOC 2021): Non-pharmacological Treatment Update. Arch Bronconeumol 2022; 58:345-351. [PMID: 35312554 DOI: 10.1016/j.arbres.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/02/2022]
Abstract
In addition to recommendations for pharmacological treatment stratified for risk and phenotype, the new 2021 edition of the Spanish COPD Guidelines (GesEPOC 2021) proposes a personalized approach to treatable traits, defined as a characteristic (clinical, physiological, or biological) that can be identified by diagnostic tests or biomarkers, for which a specific treatment is available. Some treatable traits, such as malnutrition, sedentarism, emphysema or respiratory failure, can be treated with non-pharmacological therapies, and this was not covered in detail in the guidelines. This section of GesEPOC 2021 includes a narrative update with recommendations on dietary treatment, physical activity, respiratory rehabilitation, oxygen therapy, non-invasive ventilation, volume reduction, and lung transplantation. A PICO question with recommendations on the use of supplemental oxygen during exercise in COPD patients without severe hypoxemia is also included.
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Affiliation(s)
- Borja G Cosío
- Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Carme Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Dispositivo Transversal de Hospitalización a Domicilio, Hospital Clinic de Barcelona, Barcelona, España
| | - Eusebi Chiner
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Elena Gimeno-Santos
- Servicio de Neumología, Hospital Clínico de Barcelona; Programa de enfermedades no transmisibles y medio ambiente, Instituto de Salud Global (ISGlobal) de Barcelona, Barcelona, España
| | - Eulogio Pleguezuelos
- Servicio de Medicina Física y Rehabilitación, Hospital de Mataró, Mataró (Barcelona), España
| | - Nuria Seijas
- Dispositivo Transversal de Hospitalización a Domicilio, Hospital Clinic de Barcelona, Barcelona, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, España
| | - Juan José Soler-Cataluña
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Arnau de Vilanova, Valencia, España
| | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Ciro Casanova
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario de La Candelaria, Universidad de La Laguna, Tenerife, España
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11
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Marchese R, Lo Nigro C, Scaduto F. Use of bronchoscopic steam thermal ablation (BTVA) in a clinically compromised patient. J Cardiothorac Surg 2022; 17:16. [PMID: 35130938 PMCID: PMC8822822 DOI: 10.1186/s13019-022-01756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bronchoscopic lung volume reduction (BLVR) techniques improve lung function and increase exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) and BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for these patients. BTVA (Intervapor Uptake Medical, Tustin, CA, USA) represents a recent therapy of this group that allows to treat sublobar areas and for this reason is used clinically compromised patients, like in this case report.
Case presentation In this paper we describe a case report of an 85-year-old male with severe respiratory failure and a diagnosis of emphysema presented with dyspnea and clinical worsening, despite the best medical therapy practiced. For comorbidity and pathology’s features he was excluded from surgical treatment options, like lung volume reduction surgical (LVRS) and from positioning of endobronchial valves (EBV) for the presence of collateral ventilation and he was addressed to BTVA. The procedure was successful for this patient.
Conclusions This case supports recent suggestions that BTVA can be a good alternative treatment for patients properly selected.
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Affiliation(s)
- Roberto Marchese
- Private Hospital La Maddalena: Casa di Cura La Maddalena SpA, Palermo, Italy.
| | - Chiara Lo Nigro
- Private Hospital La Maddalena: Casa di Cura La Maddalena SpA, Palermo, Italy
| | - Federica Scaduto
- Private Hospital La Maddalena: Casa di Cura La Maddalena SpA, Palermo, Italy
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12
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Konoeda C, Sato M, Nagayama K, Nakajima J. Simultaneous single lobar lung transplantation and contralateral lung volume reduction. Eur J Cardiothorac Surg 2021; 59:1342-1344. [PMID: 33367595 DOI: 10.1093/ejcts/ezaa459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Lung transplantation (LTx) and lung volume reduction surgery are established therapies for end-stage chronic obstructive pulmonary disease. Although native lung hyperinflation is a well-known complication of unilateral LTx for chronic obstructive pulmonary disease, the unilateral procedure continues to be performed because of severe shortages of cadaveric donors. As native lung hyperinflation can adversely affect the graft, all possible protection should be provided for patients with one-lobe transplantation. We report an emphysematous juvenile patient who successfully underwent simultaneous living-donor, single-lobe LTx and volume reduction in the contralateral lung.
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Affiliation(s)
- Chihiro Konoeda
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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13
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Randhawa S, Meyers B. Future Treatment of Emphysema with Roles for Valves, Novel Strategies and Lung Volume Reduction Surgery. Thorac Surg Clin 2021; 31:221-227. [PMID: 33926675 DOI: 10.1016/j.thorsurg.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although there are multiple pharmacologic and nonpharmacological options to alleviate symptoms of emphysema, none of these treatment modalities halts disease progression. The expanding disease burden has led to development of innovative therapeutic strategies that also aim to induce lung volume reduction. Bronchoscopic lung volume reduction originated in 2001 and has continued to grow rapidly ever since. This article discusses more recent developments in bronchoscopic and novel interventions and speculates on how these novel strategies may impact the future of lung reduction interventions.
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Affiliation(s)
- Simran Randhawa
- Washington University School of Medicine, Barnes-Jewish Hospital, Campus Box 8234, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA
| | - Bryan Meyers
- Washington University School of Medicine, Barnes-Jewish Hospital, Campus Box 8234, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Sanders K, Klooster K, Vanfleteren LEGW, Plasqui G, Dingemans AM, Slebos DJ, Schols AMWJ. Effect of Bronchoscopic Lung Volume Reduction in Advanced Emphysema on Energy Balance Regulation. Respiration 2021; 100:1-8. [PMID: 33550302 DOI: 10.1159/000511920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypermetabolism and muscle wasting frequently occur in patients with severe emphysema. Improving respiratory mechanics by bronchoscopic lung volume reduction (BLVR) might contribute to muscle maintenance by decreasing energy requirements and alleviating eating-related dyspnoea. OBJECTIVE The goal was to assess the impact of BLVR on energy balance regulation. DESIGN Twenty emphysematous subjects participated in a controlled clinical experiment before and 6 months after BLVR. Energy requirements were assessed: basal metabolic rate (BMR) by ventilated hood, total daily energy expenditure (TDEE) by doubly labelled water, whole body fat-free mass (FFM) by deuterium dilution, and physical activity by accelerometry. Oxygen saturation, breathing rate, and heart rate were monitored before, during, and after a standardized meal via pulse oximetry and dyspnoea was rated. RESULTS Sixteen patients completed follow-up, and among those, 10 patients exceeded the minimal clinically important difference of residual volume (RV) reduction. RV was reduced with median (range) 1,285 mL (-2,430, -540). Before BLVR, 90% of patients was FFM-depleted despite a normal BMI (24.3 ± 4.3 kg/m2). BMR was elevated by 130%. TDEE/BMR was 1.4 ± 0.2 despite a very low median (range) daily step count of 2,188 (739, 7,110). Following BLVR, the components of energy metabolism did not change significantly after intervention compared to before intervention, but BLVR treatment decreased meal-related dyspnoea (4.1 vs. 1.7, p = 0.019). CONCLUSIONS Impaired respiratory mechanics in hyperinflated emphysematous patients did not explain hypermetabolism. Clinical Trial Registry Number: NCT02500004 at www.clinicaltrial.gov.
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Affiliation(s)
- Karin Sanders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lowie E G W Vanfleteren
- COPD Centre, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Guy Plasqui
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne-Marie Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands,
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Franzen D, Straub G, Steinack C. Bronchoscopic thermal vapor ablation after unsuccessful lung volume reduction surgery: A case report. Respir Med Case Rep 2020; 30:101048. [PMID: 32280583 PMCID: PMC7139157 DOI: 10.1016/j.rmcr.2020.101048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 11/23/2022] Open
Abstract
Compared to surgery there is no evidence on bronchoscopic lung volume reduction (LVR) in patients with fading benefit after LVR surgery. CASE REPORT: We present a case of 64-year old female patient who was successfully treated with bronchial thermal vapor ablation (BTVA) after previous ineffective lung volume reduction (LVR) surgery several months earlier. CONCLUSIONS: Bronchoscopic LVR, in particular BTVA, might be considered in patients with fading or missing effects after previous LVRS. At least, the safety profile of BTVA seems not be adversely affected by previous LVRS, when proper patient selection and procedure planning are ensured.
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Affiliation(s)
- Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Gilles Straub
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Carolin Steinack
- Department of Pulmonology, University Hospital Zurich, 8091, Zurich, Switzerland
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20
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Hetzel J, Boeckeler M, Lewis RA, Horger M, Haentschel M. Use of 3-D navigation to target the site of autologous blood installation for lung volume reduction in bullous emphysema. Chron Respir Dis 2020; 17:1479973120903556. [PMID: 32053039 PMCID: PMC7019502 DOI: 10.1177/1479973120903556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) using intrabullous autologous blood instillation has been reported in single cases where other techniques are not possible. We present the use of three-dimensional navigation to instill autologous blood into emphysematous bullae for BLVR. A 62-year-old man presented with increasing dyspnea, due to emphysema with a conglomerate of giant bullae with two particularly large bullae. Surgical treatment was refused, so bronchoscopic autologous blood instillation into the bronchial segment leading to the large bullae was attempted, but was unsuccessful; blood failed to penetrate into the bullous cavity. Dyspnea worsened over the following year. We therefore performed another bronchoscopy and punctured a large bulla with a needle and created a tunnel from the central airways. Puncture position and direction were determined using a prototype of an electromagnetic navigation system. Under fluoroscopic guidance, a catheter was placed via the tunnel into the bulla and blood was instilled. This resulted in an almost complete shrinkage of the bullae, reduction of residual volume, and marked improvement in dyspnea within 4 months. To our knowledge, this is the first reported case of successful BLVR by navigated bronchoscopy with transbronchial puncture, dilatation, and autologous blood instillation into a giant bulla.
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Affiliation(s)
- Juergen Hetzel
- Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Michael Boeckeler
- Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany
| | | | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Maik Haentschel
- Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Klooster K, van Dijk M, Koster TD, Slebos DJ. First in Human Experience of the Performance of the New 5.5-LP Size Zephyr Endobronchial Valve. Respiration 2019; 99:50-55. [PMID: 31770763 DOI: 10.1159/000504182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction using the Zephyr® endobronchial valve (EBV) is a guideline treatment for patients with advanced emphysema. To achieve volume reduction, it is crucial that there is absence of collateral ventilation and a complete occlusion of the target lobe. While 3 EBV sizes (4.0; 4.0-LP; and 5.5) are currently available to accommodate all airway sizes, local anatomical variations sometimes warrant a valve with a wide diameter but shorter length. To address this, a new "low profile" 5.5-LP EBV has been introduced. OBJECTIVE In this study, we evaluated the feasibility, safety, and efficacy of this new 5.5-LP EBV. METHODS This was a single-center, prospective, open-label study. Patients were included if eligible for valve treatment with a local anatomy suitable to place at least one 5.5-LP EBV. Feasibility of placement of the 5.5-LP EBV was reported. Safety, CT parameters, pulmonary function tests, and St. George's Respiratory Questionnaire (SGRQ) were assessed at baseline and 6 weeks after treatment. RESULTS We included 30 patients with severe chronic obstructive pulmonary disease (forced expiratory volume in 1 s [FEV1] 29 ± 10%; [RV] 242 ± 46%; and SGRQ 56 ± 11 points). Besides the regular EBV sizes, a median of 1 (1-3) of the new 5.5-LP EBV was placed. No valve adjustment was needed during the initial procedure. A single asymptomatic small pneumothorax was observed in 1 patient. In 4 patients, a revision bronchoscopy was performed due to absence of clinical benefit. In 1 patient, this was related to a dislocation of the 5.5-LP EBV. Clinically relevant improvements were seen in target lobar volume reduction (-1,554 mL), FEV1 +39%, RV -960 mL, and SGRQ -18 points. CONCLUSIONS In this first in human study, the 5.5-LP EBV could be placed into wide segments with a shorter landing length without unexpected complications and with good efficacy outcomes.
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Affiliation(s)
- Karin Klooster
- Department of Pulmonary Diseases, UMCG Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands,
| | - Marlies van Dijk
- Department of Pulmonary Diseases, UMCG Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - T David Koster
- Department of Pulmonary Diseases, UMCG Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, UMCG Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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Kayani K, Mahadeva R, Stinchcombe S, Rutter M, Babar J, Fuld J. Lung function improvements in emphysema following pneumonia. Respir Med Case Rep 2018; 26:1-5. [PMID: 30416955 PMCID: PMC6216104 DOI: 10.1016/j.rmcr.2018.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/12/2022] Open
Abstract
We describe two cases of patients with emphysema who, in the lead up to hyperinflation intervention, developed pneumonia with significant physiological, anatomical, functional and quality of life improvement observed following. This directly goes against the natural history of both disease processes, demonstrating the benefit resulting from infective autobullectomy.
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Key Words
- 6MWD, 6 Minute Walking Distance
- Autobullectomy
- BODE, Body mass index, airflow Obstruction, Dyspnea and Exercise capacity
- CAT, COPD Assessment Test
- COPD
- COPD, Chronic Obstructive Pulmonary Disease
- CT, Computed Tomography
- EBC, Endobronchial Coil
- EBV, Endobronchial Valves
- FEV1, Forced Expiratory Volume in one second
- FeNO, Fractional exhaled Nitric Oxide
- GOLD, Global initiative for chronic Obstructive Lung Disease
- IgE, Immunoglobulin E
- KCO, transfer coefficient of diffusion
- LVRS, Lung Volume Reduction Surgery
- Lung volume reduction
- MCID, Minimal Clinically Important Difference
- NICE, National Institute for Health and Care Excellence
- RV, Residual Volume
- SGRQ, St Georges Respiratory Questionnaire
- VA, alveolar volume
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Affiliation(s)
- Kayani Kayani
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ravi Mahadeva
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - Sîan Stinchcombe
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - Matthew Rutter
- Lung Function Unit, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - Judith Babar
- Department of Radiology Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - Jonathan Fuld
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
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27
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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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28
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Pietzsch JB, Busca R, Rott C, Geisler BP, Weber SA, Slebos DJ, Deslee G, Herth FJF. Adoption Patterns of Bronchoscopic Lung Volume Reduction Procedures in Germany and Predicted Procedure Volumes for Other European Countries. Respiration 2018; 97:34-41. [PMID: 30121662 DOI: 10.1159/000491677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) using valves and coils has been approved for use since 2003 and 2010, respectively. OBJECTIVE(S) To study adoption patterns of BLVR in an early-adopting country, and to estimate potential treatment volumes in other European countries. METHODS Therapy- and age-specific volumes for endobronchial valve and coil procedures were obtained from German federal statistics for 2007-2016. Therapy-specific and total BLVR procedure volumes and growth were computed, and patterns in treatment age and device utilization analyzed. Patient volumes for other European countries were predicted using mean German patient volumes of the last 3 data years and age-specific population and emphysema incidences. RESULTS Over the study period, annual BLVR procedure volumes grew from 91 to 2,053 (+2,256%), reaching a peak of 2,556 procedures in 2013. Coil procedures constituted 36% of the total volume in 2016. Treatment age was stable over time, with highest procedure counts in age group 60-64 years for valves and 65-69 years for coils. A limited increase in device use per procedure was observed. For -Germany, 1,655 newly treated BLVR patients were estimated per year, approximating about 5% of the annual newly diagnosed severe emphysema cases. Predicted volume estimates for other European countries ranged from 1 for Liechtenstein to 1,226 for France. CONCLUSIONS Analysis of -German procedure data show pronounced BLVR therapy uptake in the early years of adoption, with the more recently introduced coil therapy used in about one-third of patients. Estimated patient volumes to date constitute only a small fraction of the severe emphysema population.
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Affiliation(s)
| | - Rachele Busca
- PneumRx Ltd., a BTG International Group Company, London, United Kingdom
| | - Christina Rott
- PneumRx GmbH, a BTG International Group Company, Düsseldorf, Germany
| | - Benjamin P Geisler
- Wing Tech Inc., Menlo Park, California, USA.,Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | | | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gaëtan Deslee
- Department of Pulmonary Diseases, INSERM Unit 1250, University Hospital of Reims, Reims, France
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, Member of the German Lung Research Network, Heidelberg,
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29
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Abstract
The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.
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Affiliation(s)
- Jorrit B A Welling
- 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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30
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Straub G, Franzen D. [Not Available]. Praxis (Bern 1994) 2018; 107:379-386. [PMID: 29587594 DOI: 10.1024/1661-8157/a002937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Die endoskopische Lungenvolumenreduktion (ELVR) hat sich in den vergangenen Jahren in ausgewählten Patienten mit schwerem Lungenemphysem als valable Alternative zur chirurgischen Lungenvolumenreduktion etabliert. Die Wahl der ELVR-Technik richtet sich danach, ob zwischen dem zu behandelnden und dem benachbarten Lungenlappen Kollateralventilation vorhanden ist, was mittels computertomografischer und endoskopischer Techniken festgestellt werden kann. Als Vorteile der ELVR-Verfahren sind die geringe Invasivität mit entsprechend geringer Mortalität und Morbidität bei niedrigen Kosten zu nennen, zudem ist die Ventileinlage bei Bedarf reversibel. Die Wirksamkeit der ELVR-Verfahren (Ventile, Coils) wurde in mehreren prospektiven, randomisierten Studien belegt. Die Wahl des für den Patienten geeigneten Verfahrens zur Lungenvolumenreduktion sollte weiterhin in einer interdisziplinären Besprechung mit Thoraxchirurgen und spezialisierten Pneumologen erfolgen. La réduction du volume pulmonaire par endoscopie est devenue une importante alternative à la chirurgie chez les malades présentant un emphysème pulmonaire sévère. Le choix de la technique au niveau individuel dépend principalement de l’intégrité de la fissure interlobaire et de la présence d’une ventilation collatérale, cette dernière pouvant être déterminée par tomographie computérisée quantitative et des techniques endoscopiques. Les avantages de la réduction du volume pulmonaire par endoscopie consistent en son caractère minimalement invasif ( procédure utilisant un orifice naturel) et des coûts potentiellement réduits. Par ailleurs ce mode de réduction du volume pulmonaire permet de restaurer la ventilation en cas de besoin. Le choix de la technique appropriée chez un malade donné devrait être discuté de manière interdisciplinaire dans le cadre d’un groupe comportant des pneumologues interventionnels et des chirurgiens thoraciques.
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Affiliation(s)
- Gilles Straub
- 1 Interventionelles Lungenzentrum, Klinik für Pneumologie, Universitätsspital Zürich
| | - Daniel Franzen
- 1 Interventionelles Lungenzentrum, Klinik für Pneumologie, Universitätsspital Zürich
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31
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van Geffen WH, Klooster K, Hartman JE, Ten Hacken NHT, Kerstjens HAM, Wolf RFE, Slebos DJ. Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment. Respiration 2017. [PMID: 28637047 DOI: 10.1159/000477258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. OBJECTIVE To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. METHODS HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). RESULTS The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. CONCLUSION A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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32
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Kumar A, Dy R, Singh K, Jeffery Mador M. Early Trends in Bronchoscopic Lung Volume Reduction: A Systematic Review and Meta-analysis of Efficacy Parameters. Lung 2016; 195:19-28. [PMID: 28005150 DOI: 10.1007/s00408-016-9969-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The goal of our systematic review and meta-analysis is to examine the therapeutic effectiveness of bronchoscopic lung volume reduction (BLVR), and to compare it with medical management and lung volume reduction surgery. METHODS Variables of interest were absolute change in FEV1, 6MWT, and SGRQ. Meta-analysis was performed for the BLVR modalities with ≥3 trials. Of the 18 shortlisted publications, only valves (four trials; n = 159) and coils (six trials; n = 194) qualified for meta-analysis. To avoid redundant reporting for valves, only the data for intact fissure subjects were analyzed. Outcome data are presented as the mean difference from baseline with 95% confidence interval at 6-months follow-up. RESULTS For BLVR using valves, the pooled mean difference (PMD) for FEV1 was 0.146 L (95% CI 0.111-0.181; p < 0.001), 6MWT was 45.225 meters (95% CI 26.954-63.495; p < 0.001), and SGRQ was -8.825 points (95% CI -14.824 to -2.825; p = 0.004). All the PMDs were statistically significant and higher than their respective minimal clinically important difference (MCID). For BLVR using coils, the PMD for FEV1 was 0.080 L (95% CI 0.057-0.104; p < 0.001), 6MWT was 45.320 meters (95% CI 28.040-62.600; p < 0.001), and SGRQ was -10.570 points (95% CI -13.299 to -7.841; p < 0.001). All three variables showed statistically significant PMDs but that for FEV1 was smaller than the MCID. Data from BLVR modalities with <3 major publications are reviewed in the discussion section. CONCLUSIONS BLVR offers early promise in the palliation of advanced emphysema. Better characterization of patients to identify phenotypes that will derive sustained benefit is needed.
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Affiliation(s)
- Abhishek Kumar
- Mercy Medical Center, Cedar Rapids, IA, USA. .,State University of New York/University at Buffalo, Buffalo, NY, USA.
| | - Rajany Dy
- State University of New York/University at Buffalo, Buffalo, NY, USA
| | | | - M Jeffery Mador
- State University of New York/University at Buffalo, Buffalo, NY, USA.,Western New York Veterans Administration Healthcare System, Buffalo, NY, USA
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de Oliveira HG, Cruz FF, Antunes MA, de Macedo Neto AV, Oliveira GA, Svartman FM, Borgonovo T, Rebelatto CLK, Weiss DJ, Brofman PRS, Morales MM, Lapa E Silva JR, Rocco PRM. Combined Bone Marrow-Derived Mesenchymal Stromal Cell Therapy and One-Way Endobronchial Valve Placement in Patients with Pulmonary Emphysema: A Phase I Clinical Trial. Stem Cells Transl Med 2016; 6:962-969. [PMID: 28186686 PMCID: PMC5442791 DOI: 10.1002/sctm.16-0315] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 01/31/2023] Open
Abstract
One-way endobronchial valves (EBV) insertion to reduce pulmonary air trapping has been used as therapy for chronic obstructive pulmonary disease (COPD) patients. However, local inflammation may result and can contribute to worsening of clinical status in these patients. We hypothesized that combined EBV insertion and intrabronchial administration of mesenchymal stromal cells (MSCs) would decrease the inflammatory process, thus mitigating EBV complications in severe COPD patients. This initial study sought to investigate the safety of this approach. For this purpose, a phase I, prospective, patient-blinded, randomized, placebo-controlled design was used. Heterogeneous advanced emphysema (Global Initiative for Chronic Lung Disease [GOLD] III or IV) patients randomly received either allogeneic bone marrow-derived MSCs (108 cells, EBV+MSC) or 0.9% saline solution (EBV) (n = 5 per group), bronchoscopically, just before insertion of one-way EBVs. Patients were evaluated 1, 7, 30, and 90 days after therapy. All patients completed the study protocol and 90-day follow-up. MSC delivery did not result in acute administration-related toxicity, serious adverse events, or death. No significant between-group differences were observed in overall number of adverse events, frequency of COPD exacerbations, or worsening of disease. Additionally, there were no significant differences in blood tests, lung function, or radiological outcomes. However, quality-of-life indicators were higher in EBV + MSC compared with EBV. EBV + MSC patients presented decreased levels of circulating C-reactive protein at 30 and 90 days, as well as BODE (Body mass index, airway Obstruction, Dyspnea, and Exercise index) and MMRC (Modified Medical Research Council) scores. Thus, combined use of EBV and MSCs appears to be safe in patients with severe COPD, providing a basis for subsequent investigations using MSCs as concomitant therapy. Stem Cells Translational Medicine 2017;6:962-969.
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Affiliation(s)
- Hugo Goulart de Oliveira
- Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Ferreira Cruz
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | - Mariana Alves Antunes
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | - Amarilio Vieira de Macedo Neto
- Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Fabio Munhoz Svartman
- Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Tamara Borgonovo
- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - Daniel J Weiss
- Vermont Lung Center, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Marcelo Marcos Morales
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Patricia Rieken Macedo Rocco
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
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Bocquillon V, Briault A, Reymond E, Arbib F, Jankowski A, Ferretti G, Pison C. [Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema]. Rev Mal Respir 2016; 33:794-8. [PMID: 27444697 DOI: 10.1016/j.rmr.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. CASE REPORT A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. CONCLUSION The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine.
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Elshafie G, Kumar P, Motamedi-Fakhr S, Iles R, Wilson RC, Naidu B. Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study. Interact Cardiovasc Thorac Surg 2016; 23:544-7. [PMID: 27316661 DOI: 10.1093/icvts/ivw185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We describe the use of structured light plethysmography (SLP)-a novel, non-contact, light-based technique for measuring tidal breathing-among a cohort of patients undergoing lung resection. In this feasibility study, we examined whether changes in chest wall motion or in asynchrony between regions of the thoraco-abdominal wall could be identified after surgery. METHODS Fifteen patients underwent wedge resection (n = 8) or lobectomy (n = 7). All patients underwent two SLP assessments (before surgery and on Day 1 post-surgery). Each assessment captured data during 5 min of quiet (tidal) breathing. RESULTS When data were averaged across all patients, motion on the operated side of the thorax was significantly reduced after surgery (mean change from presurgery ± standard deviation: -14.7 ± 16.5%, P = 0.01), while motion on the non-operated side increased (15.9 ± 18.5%, P = 0.01). Thoraco-abdominal asynchrony also increased (mean change ± standard deviation: 43.4 ± 55.1%, P = 0.01), but no significant difference was observed in right-left hemi-thoracic asynchrony (163.7 ± 230.3%, P = 0.08). When analysed by resection type, lobectomy was associated with reduced and increased motion on the operated and non-operated side, respectively, and with an increase in both right-left hemi-thoracic and thoraco-abdominal asynchrony. No significant changes in motion or asynchrony were identified in patients who underwent wedge resection. CONCLUSIONS SLP was able to detect changes in chest wall motion and asynchrony after thoracic surgery. Changes in this small group of patients were consistent with the side of the incision and were most apparent in patients undergoing lobectomy.
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Affiliation(s)
- Ghazi Elshafie
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
| | - Prem Kumar
- School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
| | | | - Richard Iles
- PneumaCare Ltd, Prospect House, Ely, Cambridgeshire, UK Evelina London Children's Hospital, London, UK
| | | | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
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Hartman JE, Klooster K, Slebos DJ, Ten Hacken NHT. Improvement of physical activity after endobronchial valve treatment in emphysema patients. Respir Med 2016; 117:116-21. [PMID: 27492521 DOI: 10.1016/j.rmed.2016.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE Bronchoscopic lung volume reduction using endobronchial valves is a promising treatment for severe emphysema patients without collateral ventilation. Physical activity is an important contributing factor for the autonomy, morbidity and mortality of these patients. OBJECTIVE We investigated the impact of endobronchial valve treatment on physical activity in severe emphysema patients. METHODS Physical activity was measured for 7 days by a triaxial accelerometer at baseline and 6 months follow-up after EBV treatment, and compared with standard medical care in a randomized controlled trial. RESULTS Forty-three patients (77%female, age 59 ± 9years, FEV1 30 ± 7%pred, steps 3563 ± 2213per/day) wore the accelerometer and were included in the analysis. Nineteen patients received EBV treatment and 24 standard medical care. At baseline, physical activity level was comparable between groups. After 6 months, the endobronchial valve group significantly improved compared to the controls in steps/day (+1252vs-148) and locomotion time (+17vs-2 min/day). Change in sit duration (0vs + 27 min/day) did not significantly differ. CONCLUSIONS Physical activity significantly improved after endobronchial valve treatment in severe emphysema patients. This improvement was without any specific encouragement on physical activity. CLINICAL TRIAL NUMBER Dutch trial register: NTR2876.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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Kostron A, Horn-Tutic M, Franzen D, Kestenholz P, Schneiter D, Opitz I, Kohler M, Weder W. Repeated lung volume reduction surgery is successful in selected patients. Eur J Cardiothorac Surg 2014; 48:710-5. [PMID: 25548131 DOI: 10.1093/ejcts/ezu498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/18/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Lung volume reduction surgery (LVRS) improves dyspnoea, quality of life and may even prolong survival in carefully selected patients with end-stage emphysema. The benefit may be sustained for several years and vanishes with the natural progression of the disease. Data on repeated surgical treatment of emphysema are scarce. The aim of this study was to evaluate the safety, effects and outcomes of repeated LVRS (Re-LVRS) in patients no longer benefiting from their initial LVRS. METHODS Between June 2002 and December 2013, 22 patients (9 females) with advanced emphysema underwent Re-LVRS at a median of 60 months (25-196) after their initial LVRS. While initial LVRS was performed thoracoscopically as a bilateral procedure, Re-LVRS was performed unilaterally by a video-assisted thoracoscopic technique in 19 patients and, due to adhesions, by thoracotomy in 3 patients. Pulmonary function test (PFT) was performed at 3 and 12 months postoperatively. RESULTS Lung function at Re-LVRS was similar to that prior to the first LVRS. The 90-day mortality rate was 0%. The first patient died 15 months postoperatively. The median hospitalization time after Re-LVRS was significantly longer compared with the initial LVRS [14 days, interquartile range (IQR): 11-19, vs 9 days, IQR: 8-14; P = 0.017]. The most frequent complication was prolonged air leak with a median drainage time of 11 days (IQR: 6-13); reoperations due to persistent air leak were necessary in 7 patients (32%). Five patients (23%) had no complications. Lung function and Medical Research Council (MRC) score improved significantly for up to 12 months after Re-LVRS, with results similar to those after initial bilateral LVRS. The average increase in the forced expiratory volume in 1 s (FEV1) was 25% (a 7% increase over the predicted value or 0.18 l) at 3 months, and the mean reduction in hyperinflation, assessed by relative decrease in RV/TLC (residual volume/total lung capacity), was 12% at 3 months (a decrease of 8% in absolute ratios). The mean MRC breathlessness score decreased significantly after 3 months (from 3.7 to 2.2). CONCLUSIONS Re-LVRS can be performed successfully in carefully selected patients as a palliative treatment. It may be performed as a bridge to transplantation or in patients with newly diagnosed intrapulmonary nodules or during elective cardiac surgery. Morbidity is acceptable and outcomes may be satisfactory with significantly improved lung function and reduced dyspnoea for at least 12 months postoperatively.
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Affiliation(s)
- Arthur Kostron
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Michaela Horn-Tutic
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Daniel Franzen
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Peter Kestenholz
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery and Division of Pulmonology, University Hospital, Zurich, Switzerland
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Abstract
The management of obstructive lung disease, particularly emphysematous lung disease, is aggressively being pursued. The patient populations that will experience the greatest benefit with lung volume reduction are those that are the worst candidates for surgical intervention. Identifying a bronchoscopic approach that has a true impact on this patient population will be a major accomplishment in the management of patients with chronic obstructive pulmonary disease. This article highlights the work currently ongoing in the area of bronchoscopic lung volume reduction. There are tools now clinically available in some locations throughout the world, but no standardized technique exists.
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Affiliation(s)
- Michael J Simoff
- Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
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Votruba J, Collins J, Herth F. Successful treatment of ventilator dependent emphysema with Chartis treatment planning and endobronchial valves. Int J Surg Case Rep 2011; 2:285-7. [PMID: 22096755 PMCID: PMC3215251 DOI: 10.1016/j.ijscr.2011.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 08/05/2011] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Emphysema is a leading cause of disability and death. Patients who require ventilator support as a result of respiratory failure have limited treatment options. We report a successful outcome for a ventilator dependent patient in whom endobronchial valves were inserted into lobes assessed as being without collateral ventilation. PRESENTATION OF CASE A 54 year old male patient had been ventilator dependent for two months due to respiratory insufficiency from emphysema. Prior to admission, FEV(1) was 0.89L (25% predicted) and RV was 4.5L (205% predicted). CT scan showed destruction of right lower and middle lobes and left lower lobe. Chartis assessment showed the absence of collateral ventilation. Zephyr endobronchial valves were placed in left and right lower lobes. Lung volume reduction bilaterally was confirmed on chest X-ray and CT scan the following day. On day three, ventilator support was discontinued and there was no requirement for supplementary oxygen. At 30 days post procedure, the RV reduced to 3.2L (142% predicted) and the FEV(1) increased to 1.32L (38% predicted). DISCUSSION Hyperinflation in emphysema compromises lung function. For this ventilator dependent patient, there were no other treatment options. Endoscopic lung volume reduction was successfully achieved by bilateral lower lobe placement of Zephyr endobronchial valves with a prior assessment using Chartis to determine the absence of collateral flow in the targeted lobes. The patient achieved an impressive 48% improvement in FEV(1) and a 29% reduction in RV. CONCLUSION Endoscopic lung volume reduction assisted by Chartis to plan treatment resulted in a clinical and a health-economic benefit.
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Affiliation(s)
- J. Votruba
- Na Homolce, Interni Oddeleni-Pneumologie, Roentgenova 2, 150 30 Prague 5, Czech Republic
| | - J. Collins
- Pulmonx International Sàrl, Rue de la Gare 4, 2034 Peseux, Switzerland
| | - F.J.F. Herth
- Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, Germany
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