Interventions In Asthma and COPD

2019 ◽  
Vol 76 (6) ◽  
pp. 328-336
Author(s):  
Neha P. Mandovra ◽  
Jörg D. Leuppi ◽  
Felix J. F. Herth ◽  
Prashant N. Chhajed
Keyword(s):  
Severe Asthma ◽  
Lung Volume ◽  
Volume Reduction ◽  
Significant Morbidity ◽  
Lung Volume Reduction ◽  
Bronchial Thermoplasty ◽  
Clinical Trial Evidence ◽  
Clinical Benefits ◽  
Randomised Controlled ◽  
Prolonged Hospital

Abstract. Advanced emphysema and asthma constitute major health burden worldwide and are associated with significant morbidity and mortality. Pharmacological options are limited. Researches are being carried out aiming to modify the natural course of both the diseases. Lung volume reduction surgeries are performed in advanced emphysema but are associated with significant morbidity and prolonged hospital stay. Various minimally invasive bronchoscopic methods have been developed with the goal of achieving clinical benefits of volume reduction surgery but lower complications. Bronchial thermoplasty is a bronchoscopic method of delivering controlled heat in the airways to reduce airway smooth muscle mass, thereby reducing bronchoconstriction in patients with severe asthma who remain uncontrolled despite optimal medical therapy. Various randomised controlled trials have been performed to evaluate the safety and efficacy of various endoscopic treatments like valves, coils, use of sclerosants and targeted lung denervation for severe emphysema and bronchial thermoplasty in severe asthma. The current review summaries the clinical trial evidence available for lung volume reduction in emphysema and thermoplasty in asthma and provide guidance for optimal patient selection for various therapies available.

scholarly journals CELEB trial: Comparative Effectiveness of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: a protocol for a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021368 ◽  
Author(s):  
Sara Buttery ◽  
Samuel V Kemp ◽  
Pallav L Shah ◽  
David Waller ◽  
Simon Jordan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Exercise Capacity ◽  
Lung Volume ◽  
Clinical Decision Making ◽  
Controlled Trial ◽  
Airflow Obstruction ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Randomised Controlled

IntroductionAlthough lung volume reduction surgery and bronchoscopic lung volume reduction with endobronchial valves have both been shown to improve lung function, exercise capacity and quality of life in appropriately selected patients with emphysema, there are no direct comparison data between the two procedures to inform clinical decision-making.Methods and analysisWe describe the protocol of the CELEB study, a randomised controlled trial which will compare outcomes at 1 year between the two procedures, using a composite disease severity measure, the iBODE score, which includes body mass index, airflow obstruction, dyspnoeaand exercise capacity (incremental shuttle walk test).Ethics and disseminationEthical approval to conduct the study has been obtained from the Fulham Research Ethics Committee, London (16/LO/0286). The outcome of this trial will provide information to guide treatment choices in this population and will be presented at national and international meetings and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter.Trial registration numberISRCTN19684749; Pre-results.

scholarly journals Endobronchial valves for severe emphysema

2019 ◽  
Vol 28 (152) ◽  
pp. 180121 ◽  
Author(s):  
Jorine E. Hartman ◽  
Lowie E.G.W. Vanfleteren ◽  
Eva M. van Rikxoort ◽  
Karin Klooster ◽  
Dirk-Jan Slebos
Keyword(s):  
Lung Volume ◽  
Treatment Guidelines ◽  
Routine Care ◽  
Volume Reduction ◽  
Future Research ◽  
Lung Volume Reduction ◽  
Regular Treatment ◽  
Number Of Patients ◽  
Predictive Risk ◽  
Randomised Controlled

The results of the randomised controlled trials investigating the bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) are promising, and have led to their inclusion in treatment guidelines, US Food and Drug Administration approval and inclusion in routine care in an increasing number of countries. The one-way valve treatment has advanced and is now a regular treatment option. However, this new phase will lead to new challenges in terms of implementation. We believe that key issues in future research concern advanced patient selection, improved methods for target lobe selection, increased knowledge on the predictive risk of a pneumothorax, positioning of pulmonary rehabilitation in conjunction with the EBV treatment, the positioning of lung volume reduction surgeryversusEBV treatment, and the long-term efficacy, adverse events, impact on exacerbations and hospitalisations, costs and survival. Hopefully, the increasing number of patients treated, the setup of (inter)national registries and future research efforts will further optimise all aspects of this treatment.

scholarly journals Endobronchial Valve (Zephyr) Treatment in Homogeneous Emphysema: One-Year Results from the IMPACT Randomized Clinical Trial

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Ralf Eberhardt ◽  
Dirk-Jan Slebos ◽  
Felix J.F. Herth ◽  
Kaid Darwiche ◽  
Manfred Wagner ◽  
...  
Keyword(s):  
Lung Volume ◽  
Standard Of Care ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Serious Adverse Events ◽  
Bode Index ◽  
Clinical Benefits ◽  
The Mean ◽  
The Impact ◽  
Collateral Ventilation

<b><i>Rationale:</i></b> The long-term safety and effectiveness of bronchoscopic lung volume reduction with Zephyr endobronchial valves in subjects with severe homogeneous emphysema with little to no collateral ventilation beyond 3 months have yet to be established. <b><i>Methods:</i></b> Ninety-three subjects were randomized to either bronchoscopic lung volume reduction with Zephyr valves or standard of care (SoC) (1:1). Zephyr valve subjects were assessed at 3, 6, and 12 months. SoC subjects were assessed at 3 and 6 months; they were then offered crossover to Zephyr valve treatment. <b><i>Results:</i></b> The mean group difference (Zephyr valve – SoC) for change in FEV<sub>1</sub> from baseline to 6 months was 16.3 ± 22.1% (mean ± SD; <i>p</i> &#x3c; 0.001). Secondary outcomes showed the mean between-group difference for the six-minute walk distance of +28.3 ± 55.3 m (<i>p</i> = 0.016); St. George’s Respiratory Questionnaire, −7.51 ± 9.56 points (<i>p</i> &#x3c; 0.001); modified Medical Research Council, −0.42 ± 0.81 points (<i>p</i> = 0.019); BODE index, −0.85 ± 1.39 points (<i>p</i> = 0.006); and residual volume of −430 ± 830 mL (<i>p</i> = 0.011) in favor of the Zephyr valve group. At 6 months, there were significantly more responders based on the minimal clinically important difference for these same measures in the Zephyr valve versus the SoC group. The clinical benefits were persistent at 12 months. The percentage of subjects with respiratory serious adverse events was higher in the Zephyr valve group compared to SoC during the first 30 days post-procedure but not statistically different for the Zephyr valve and SoC groups from 31 days to 6 months, and stable in the Zephyr valve group out to 12 months. There were 2 deaths in the SoC group in the 31-day to 6-month period and none in the Zephyr valve group out to 12 months. <b><i>Conclusions:</i></b> Bronchoscopic lung volume reduction with Zephyr valves in subjects with severe homogeneous emphysema and little to no collateral ventilation provides clinically meaningful change from baseline in lung function, quality of life, exercise capacity, dyspnea, and the BODE index at 6 months, with benefits maintained out to 12 months.

Effects of endoscopic lung volume reduction on right ventricular myocardial function in patients with advanced emphysema

Pneumologie ◽  
2014 ◽  
Vol 68 (S 01) ◽  
Author(s):  
C Pizarro ◽  
R Schueler ◽  
C Hammerstingl ◽  
J Kreuz ◽  
U Juergens ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Lung Volume ◽  
Myocardial Function ◽  
Volume Reduction ◽  
Lung Volume Reduction

Volumetric and scintigraphic changes following endoscopic lung volume reduction

Pneumologie ◽  
2015 ◽  
Vol 69 (S 01) ◽  
Author(s):  
C Pizarro ◽  
H Ahmadzadehfar ◽  
M Essler ◽  
G Nickenig ◽  
D Skowasch
Keyword(s):  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction
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