Bronchoscopic lung volume reduction using coil therapy: complications and management.

Askin Gulsen

doi:10.5603/arm.a2020.0152

Abstract

Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15-45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.

Highlights

Emphysema is a chronic lung disease that causes pulmonary parenchymal damage, hyperinflation, loss of elastic recoil, and progressive dyspnea [1]
In the RENEW study, which included a 1-year follow-up, partial improvement in 6-MWT and respiratory functions were reported in those who received coil therapy compared to usual care, and any complication has been reported in 34.8% of those treated with coil therapy and 19.1% in usual care [22]
In a study of an emphysema patient group with a mean forced expiratory volume in 1 second (FEV1) of 26.7 ± 7.0%, mortality was reported as 12.7 per 100 person-years over a mean follow-up of 3.9 years [43]. These results suggest that mortality rates with bronchoscopic lung volume reduction (BLVR) are likely lower than those in untreated patients with similar morbidity

Summary

Introduction

Emphysema is a chronic lung disease that causes pulmonary parenchymal damage, hyperinflation, loss of elastic recoil, and progressive dyspnea [1]. In the last stage of emphysema, there is a marked decrease in exercise capacity and the quality of life, and a consequent restriction of daily activities. During this period, long-acting bronchodilators (b2-agonist and anti-muscarinic) and drugs (phosphodiesterase-4 inhibitors, methylxanthines, and mucolytic agents) are administered to reduce the severity of symptoms and frequency of exacerbations [2]. While medical treatment of emphysema does not impact long-term outcomes in clinical practice, invasive treatment can be administered to very few patients

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