Changes in functional capacity after endoscopic lung volume reduction in patients with chronic obstructive lung disease and severe emphysema

Abstract Emphysema is one of the pathological manifestations of chronic obstructive pulmonary disease (COPD), which leads to lung hyperinflation, decreased activity of the diaphragm, decreased compliance of the lung, and difficulties in gas exchange. The clinical effect of pharmacological treatment for patients with severe emphysema is limited. In recent years, the emergence of bronchoscopic lung volume reduction (BLVR) has opened up the possibility for the management of COPD with severe emphysema. The article aims to summarize the development, procedure, and methodology of BLVR as well as its clinical efficacy.

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Endoscopic lung volume reduction coils for patients with severe emphysema – a single-center retrospective analysis

10.21203/rs.3.rs-60941/v1 ◽

2020 ◽

Author(s):

Sebastian Mang ◽

Niklas Hus ◽

Hans-Joachim Schäfers ◽

Holger Wehrfritz ◽

Alexander Massmann ◽

...

Keyword(s):

Overall Survival ◽

Lung Function ◽

Lung Volume ◽

Volume Reduction ◽

Walking Distance ◽

Chronic Obstructive ◽

Lung Volume Reduction ◽

Bilateral Pneumothorax ◽

Severe Emphysema ◽

Major Complications

Abstract BackgroundPatients with chronic obstructive pulmonary disease (COPD) and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol-coil-based endoscopic lung volume reduction techniques have been ambiguous.Objectives The analysis was done to analyze outcomes of ELVR with nitinol-coils in patients with severe pulmonary emphysema.MethodsFrom September 2013 to November 2014, our center performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anesthesia. 12 out of 29 patients received contralateral treatments 4-6 weeks later to avoid bilateral pneumothorax. Lung function and 6-minute walking distance were assessed one week prior, one week after as well as 6 to 12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.ResultsWhile coil-based ELVR led to significant short-term improvement of vital capacity (VC, + 0.14 l ± 0.39 l, p = 0.032) and hyperinflation (ΔRV / TLC -2.32% ± 6.24%, p = 0.022), no significant changes were observed in 6-minute walking distance (6-MWD) or forced expiratory volume in one second (FEV1). Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in FEV1 or residual volume (RV) after 6 months. Adverse events included hemoptysis (40 %) and pneumothorax (3.4 %), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.ConclusionEndoscopic lung volume reduction coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.

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Predictive value of Chartis measurement for lung function improvements in bronchoscopic lung volume reduction

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620932507 ◽

2020 ◽

Vol 14 ◽

pp. 175346662093250

Author(s):

Johannes Wienker ◽

Rüdiger Karpf-Wissel ◽

Faustina Funke ◽

Christian Taube ◽

Julia Wälscher ◽

...

Keyword(s):

Lung Function ◽

Lung Volume ◽

A Priori ◽

Chronic Obstructive Lung Disease ◽

Forced Expiratory Volume ◽

Volume Reduction ◽

Functional Improvement ◽

Chronic Obstructive ◽

Lung Volume Reduction ◽

Obstructive Pulmonary Disease

Background: Bronchoscopic lung volume reduction (BLVR) via valve implantation can be achieved by targeting severely hyperinflated and emphysematously destructed lung areas in patients with chronic obstructive lung disease. Lack of collateral ventilation (CV) is important for good outcomes with BLVR. CV can be measured using the catheter-based Chartis system. The aim of this study was to evaluate the correlation between total exhaled volume drained from the target lobe measured by Chartis and clinical outcomes after BLVR in CV-negative patients. Methods: From January 2016 to March 2019, 60 patients were included in this retrospective single-center analysis. Drained volume (TVol) measured by Chartis was recorded and compared with lung function and physical performance parameters. Outcome variables included the percentage change in lung function [forced expiratory volume in 1 s (FEV1), residual volume (RV), and inspiratory vital capacity (IVC)]. Secondary outcomes were the degree of target lobe volume reduction (TLVR), change in 6-min walk distance (6MWD), and change in chronic obstructive pulmonary disease (COPD) assessment test (CAT) score. Results: Drained volume correlated significantly with post-BLVR change in FEV1 ( r = 0.663), IVC ( r = 0.611), RV ( r = −0.368), and TLVR ( r = 0.635) (all p < 0.05). In a priori-defined patient subgroups based on drained volume [<100 ml ( n = 19), 100−400 ml ( n = 33), and >400 ml ( n = 8)]; mean changes in FEV1 were 2.6%, 17.4%, and 51.3%; in RV were −3.9%, −10.6%, and −23.8%; in IVC were −4.0%, 10.6%, and 62.4%; and in TLVR were 525 ml (39%), 1375 ml (73%) and 1760 ml (100%), respectively. There were no significant correlations between absolute and percentage changes in 6MWD and the CAT score. Lung volume reduction was diagnosed in 32 (53%) cases. Conclusion: Drained volume measured by the Chartis system correlated with functional improvement in CV-negative patients undergoing BLVR. The reviews of this paper are available via the supplemental material section.

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A Bronchoscopic Steam Thermal Ablation (BTVA) Case Report in A 85-Year-Old Male Clinically Compromised

10.21203/rs.3.rs-70797/v1 ◽

2020 ◽

Author(s):

Roberto Marchese ◽

Federica Scaduto ◽

Chiara Lo Nigro

Keyword(s):

Case Report ◽

Lung Volume ◽

Treatment Guidelines ◽

Treatment Options ◽

Chronic Obstructive Lung Disease ◽

Good Alternative ◽

Volume Reduction ◽

Chronic Obstructive ◽

Lung Volume Reduction ◽

Obstructive Pulmonary Disease

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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