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 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 Interventional therapy in patients with severe emphysema: evaluation of contraindications and their incidence

2019 ◽  
Vol 13 ◽  
pp. 175346661983549 ◽  
Author(s):  
Markus Polke ◽  
Matthias Rötting ◽  
Nilab Sarmand ◽  
Johannes Krisam ◽  
Ralf Eberhardt ◽  
...  
Keyword(s):  
Lung Volume ◽  
Interventional Therapy ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Surgical Interventions ◽  
Severe Emphysema ◽  
Cardiovascular Comorbidities ◽  
Nicotine Abuse ◽  
Number Of Patients ◽  
Ventilatory Failure

Background: Endoscopic and surgical interventions may be beneficial for selected patients with emphysema. Rates of treatment failure decrease when the predictors for successful therapy are known. The aim of the study was to evaluate the number of patients with severe emphysema who were not eligible for any intervention, and the reasons for their exclusion. Methods: The study was a retrospective analysis of 231 consecutive patients with advanced emphysema who were considered for interventional therapy in 2016 at the Thoraxklinik, Heidelberg, Germany. The reasons for not receiving valve or coil therapy were assessed for all patients who did not receive any therapy. Results: Of the 231 patients, 50% received an interventional therapy for lung volume reduction (LVR) (82% valve therapy, 6% coil therapy, 4.3% polymeric LVR or bronchial thermal vapour ablation, 4.3% total lung denervation, and 3.4% lung volume reduction surgery [LVRS]). A total of 115 patients did not undergo LVR. Out of these, valve or coil therapy was not performed due to one or more of the following reasons: incomplete fissure in 37% and 0%; missing target lobe in 31% and 30%; personal decision in 18% and 28%; pulmonary function test results in 8% and 15%; ventilatory failure in 4% and 4%; missing optimal standard medical care and/or continued nicotine abuse in 4% and 3%; general condition too good in less than 1% and 3%; cardiovascular comorbidities in 0% and 3%; age of patient in 0% and less than 1%. Both techniques were not performed due to one or more of the following reasons: solitary pulmonary nodule(s)/consolidation in 27%; bronchopathy in 7%; neoplasia in 2%; destroyed lung in 2%; prior LVRS in less than 1%. Conclusions: The main reason for not placing valves was an incomplete fissure and for coils a missing target lobe. Numerous additional contraindications that may exclude a patient from interventional emphysema therapy should be respected.

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 Lung Volume Reduction Surgery for Emphysema Treatment: State-of-the-Art and Perspectives

2014 ◽  
Vol 2014 ◽  
pp. 1-17 ◽  
Author(s):  
Eugenio Pompeo
Keyword(s):  
Exercise Capacity ◽  
Lung Volume ◽  
Selection Criteria ◽  
Volume Reduction ◽  
Long Term Results ◽  
Interventional Treatment ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Severe Emphysema ◽  
Number Of Patients

Lung volume reduction surgery (LVRS) has shown an improve for up to several years respiratory function, exercise capacity, and quality of life in selected patients with severe emphysema and low exercise capacity, particularly if upper-lobe predominance of disease is radiologically recognized. However, mortality and morbidity rates of LVRS have been not negligible leading to raising question as to the cost-effectiveness of the procedure and resulting in a progressive decline in its use although a considerable number of patients meet selection criteria and could potentially benefit of this treatment modality. In recent years, an active investigation aimed at developing less invasive strategies that might allow us to achieve long-term results as satisfactory as those of the standard LVRS method but with fewer adverse effects has been undertaken. So far, novel options including nonresectional surgical and endoscopic LVRS methods hold promise but results from large studies with long follow-up are awaited to help define the most effective interventional treatment options for patients with severe emphysema. In this literature review an analysis of the main issues related to LVRS including selection criteria, mechanisms of action, results of currently available surgical and endoscopic methods, and some potential future perspectives is provided.

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

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.

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
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