scholarly journals Real life results of coil treatment for bronchoscopic lung volume reduction in emphysema

2020 ◽  
Vol 68 (1) ◽  
pp. 17-24
Author(s):  
Demet TURAN ◽  
Deniz DOĞAN ◽  
Mustafa ÇÖRTÜK ◽  
Efsun Gonca UĞUR CHOUSEIN ◽  
Elif TANRIVERDİ ◽  
...  
Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Rein Posthuma ◽  
Anouk W. Vaes ◽  
Kim H. M. Walraven ◽  
Peyman Sardari Nia ◽  
Jan U. Schreiber ◽  
...  

<b><i>Background:</i></b> Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. <b><i>Objectives:</i></b> In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. <b><i>Method:</i></b> A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV<sub>1</sub>), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample <i>t</i> tests were performed to compare means before and after intervention. <b><i>Results:</i></b> Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (<i>n</i> = 2) or lack of benefit (<i>n</i> = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT −4 ± 6 points, FEV<sub>1</sub> +190 ± 140 mL, RV −770 ± 790 mL, and +37 ± 65 m on the 6MWT (all <i>p</i> &#x3c; 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. <b><i>Conclusion:</i></b> Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.


Pneumologie ◽  
2014 ◽  
Vol 68 (S 01) ◽  
Author(s):  
C Pizarro ◽  
R Schueler ◽  
C Hammerstingl ◽  
J Kreuz ◽  
U Juergens ◽  
...  

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

Author(s):  
Van K. Holden ◽  
Sammar Alsunaid ◽  
Ananth Charya ◽  
Fahid Alghanim ◽  
Edward M. Pickering ◽  
...  

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Karin Sanders ◽  
Karin Klooster ◽  
Lowie E.G.W. Vanfleteren ◽  
Guy Plasqui ◽  
Anne-Marie Dingemans ◽  
...  

<b><i>Background:</i></b> 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. <b><i>Objective:</i></b> The goal was to assess the impact of BLVR on energy balance regulation. <b><i>Design:</i></b> 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. <b><i>Results:</i></b> 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/m<sup>2</sup>). 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, <i>p</i> = 0.019). <b><i>Conclusions:</i></b> Impaired respiratory mechanics in hyperinflated emphysematous patients did not explain hypermetabolism. <b><i>Clinical Trial Registry Number:</i></b> NCT02500004 at www.clinicaltrial.gov.


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