Bronchoscopic Lung Volume Reduction: Effect on Symptoms and Lung Function in Patients with Emphysema That Qualify for Lung Transplant

Abstract

BackgroundBronchoscopic lung volume reduction (BLVR) studies excluded patients meeting the listing criteria for lung transplantation (LT). Research QuestionWhat are the outcomes of BLVR in a sicker group of emphysematous patients compared to patients not meeting the criteria for LT listing? Study Design and MethodsReal-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLco), symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months post-BLVR. ResultsOf 76 fully evaluated patients (median age 62 years old, 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, p < 0.001), higher BODE index (6.79 ± 1.11, p = 0.001), and lower FEV1 (617.5 ± 139.2 mL, p = 0.005). All patients treated with BLVR experienced a decrease in BODE index and Borg dyspnea by -0.5 to -2 points, respectively. DLco %pred increased by 4.5%, FEV1 increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV1 at 45 days post-BLVR increased by 180.8 ± 231 mL (FEV1 %pred 5.84 ± 5.66) compared to baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18/30). Median hospital length of stay was 3.27 ± 3.07 days. Valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10/42; 5 in each group). InterpretationsImprovement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.