Abstract
BackgroundMany forms of bronchoscopic lung volume reduction were introduced as a treatment for patients with emphysema surpassing the surgical management and its fatality. Biological bronchoscopic lung volume reduction (BBLVR) proved to be a safe and competent solution inducing collapse of the emphysematous segment(s). Impulse oscillometry (IOS) constitutes an effortless but underused surrogate to spirometry in assessment of pulmonary function. Therefore, the aim of this study was to evaluate the use of IOS before and after BBLVR with histoacryl gel in comparison with spirometry among patients with emphysema.Patients and methodsA prospective comparative follow-up study was performed at Kobry El-Kobba Military Hospital. A total of 30 patients with radiological evidence of heterogenous emphysema or emphysematous bullae were enrolled during the period from July 2014 to April 2015. BBLVR was accomplished by the instillation of the histoacryl gel into the affected segment(s) using standard technique. Clinical, radiological, and functional assessments were done before and 4 weeks after the procedure.ResultsAfter BBLVR, the following outcome was measured: 6-min walk test, partial pressure of O2 in arterial blood, forced expiratory volume in the first second, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz. They improved with statistical significance among all the patients. There was a negative correlation between forced vital capacity and resistance at 5 Hz in the heterogenous emphysema group (ρ=0.47 and P<0.025); however, the forced expiratory volume at first second showed positive correlation with reactance at 5 Hz in emphysematous bullae group (ρ=0.82 and P<0.023).ConclusionBBLVR with histoacryl gel is associated with improvement in exercise capacity and lung functions. IOS provided comprehensive assessment of the pulmonary functions, which was in good correlation with spirometry.
Highlights
Many patients are receiving intensive treatment in different forms including respiratory rehabilitation, still emphysema is considered a crippling permanent disease
There was a negative correlation between forced vital capacity and resistance at 5 Hz in the heterogenous emphysema group (=0.47 and P
By spirometry [12], forced expiratory volume at first second (FEV1) to forced vital capacity (FVC) ratio was less than 70% and FEV1 was less than 45% predicted
Summary
Many patients are receiving intensive treatment in different forms including respiratory rehabilitation, still emphysema is considered a crippling permanent disease. Following the work of Cooper et al [2], surgical lung volume reduction was introduced for patients with severe heterogenous emphysema. Bronchoscopic lung volume reduction (BLVR) started to emerge after the striking results of the National Emphysema Treatment Trial where the mortality was ∼5% and postoperative complications were more than 50%. Biological bronchoscope lung volume reduction (BBLVR) proved to be a safe and efficient procedure. Many forms of bronchoscopic lung volume reduction were introduced as a treatment for patients with emphysema surpassing the surgical management and its fatality. Biological bronchoscopic lung volume reduction (BBLVR) proved to be a safe and competent solution inducing collapse of the emphysematous segment(s). The aim of this study was to evaluate the use of IOS before and after BBLVR with histoacryl gel in comparison with spirometry among patients with emphysema
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