Abstract
BACKGROUNDIncreasing randomized controlled trials (RCTs) indicate that bronchoscopic lung volume reduction (BLVR) is effective for severe emphysema. In this meta-analysis, we investigated the efficacy and safety of BLVR in patients with severe emphysema.METHODSPubMed, Embase and the Cochrane Library and reference lists of related articles were searched, and RCTs that evaluated BLVR therapy VS conventional therapy were included. Meta-analysis was performed only when included RCTs ≥ 2 trials.RESULTSIn total, 3 RCTs for endobronchial coils, 6 RCTs for endobronchial valves (EBV) and 2 RCTs for intrabronchial valves (IBV) were included. Compared with conventional therapy, endobronchial coils showed better response in minimal clinically important difference (MCID) for forced expiratory volume in 1s (FEV1) (RR = 2.37, 95% CI = 1.61 – 3.48, p < 0.0001), for 6-min walk test (6MWT) (RR = 2.05, 95% CI = 1.18 – 3.53, p = 0.01), and for St. George's Respiratory Questionnaire (SGRQ) (RR = 2.32, 95% CI = 1.77 – 3.03, p < 0.00001). EBV therapy also reached clinically significant improvement in FEV1 (RR = 2.96, 95% CI = 1.49 – 5.87, p = 0.002), in 6MWT (RR = 2.90, 95% CI = 1.24 – 6.79, p = 0.01), and in SGRQ (RR = 1.53, 95% CI = 1.22 – 1.92, p = 0.0002). Both coils and EBV treatment achieved statistically significant absolute change in FEV1, 6MWT, and SGRQ from baseline, also accompanied by serious adverse effects. Furthermore, subgroup analysis showed there was no difference between homogeneous and heterogeneous emphysema in coils group. However, IBV group failed to show superior to conventional group.CONCLUSIONSCurrent meta-analysis indicates that coils or EBV treatment could significantly improve pulmonary function, exercise capacity, and quality of life compared with conventional therapy. Coils treatment could be applied in homogeneous emphysema, but further trials are needed.
Highlights
Chronic obstructive pulmonary disease (COPD) is responsible for around 6 percent of all deaths worldwide in 2012, and will be the third leading cause of death by 2020 [1, 2]
Endobronchial coils showed better response in minimal clinically important difference (MCID) for forced expiratory volume in 1s (FEV1) (RR = 2.37, 95% confidence interval (CI) = 1.61 – 3.48, p < 0.0001), for 6-min walk test (6MWT) (RR = 2.05, 95% CI = 1.18 – 3.53, p = 0.01), and for St
endobronchial valves (EBV) therapy reached clinically significant improvement in FEV1 (RR = 2.96, 95% CI = 1.49 – 5.87, p = 0.002), in 6MWT (RR = 2.90, 95% CI = 1.24 – 6.79, p = 0.01), and in St. George’s Respiratory Questionnaire (SGRQ) (RR = 1.53, 95% CI = 1.22 – 1.92, p = 0.0002)
Summary
Chronic obstructive pulmonary disease (COPD) is responsible for around 6 percent of all deaths worldwide in 2012, and will be the third leading cause of death by 2020 [1, 2]. Lung-volume-reduction surgery (LVRS), removing damaged emphysema, allowing the relatively good lung to expand and work more efficiently, has been found to improve the quality of life and pulmonary functionfor patients with severe heterogeneous emphysema [4, 5]. Several randomized controlled trials (RCTs) have compared BLVR to medical therapy for advanced emphysema, and the results were encouraging, as confirmed in published meta-analyses [9,10,11]. Increasing randomized controlled trials (RCTs) indicate that bronchoscopic lung volume reduction (BLVR) is effective for severe emphysema. In this meta-analysis, we investigated the efficacy and safety of BLVR in patients with severe emphysema
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