Endobronchial Biologic Lung Volume Reduction (BLVR) Therapy for Unilateral Bullous Emphysema

Abstract

Background Biologic lung volume reduction (BLVR) is an experimental endobronchial treatment for advanced emphysema that reduces lung volume by remodeling damaged areas of hyperinflated lung. This article summarizes the first experience using BLVR to treat unilateral bullous disease. Methods A 67-year-old man with very severe chronic obstructive pulmonary disease owing to advanced emphysema underwent BLVR at 8 right upper lobe (RUL) subsegmental sites during 2-treatment sessions 6 weeks apart. Response to therapy was assessed 6 weeks after initial treatment, and 6 and 12 weeks after the second treatment. Results Six weeks after initial BLVR treatment at 4 subsegments, small improvements in spirometry, dyspnea [Modified Medical Research Council Dyspnea (MRCD) score=−1 U change], and a 6-minute walk distance (6MWD=+76 m change) were observed. Improvements at 6 and 12 weeks after repeat treatment in FEV1 (+20.0%, +22.1%), FVC (+33.1%, +27.6%), DLco (+6.4%, +6.3%), RV/TLC ratio (−9.8%, −5.1%), MRCD (−1 U, −1 U), 6MWD (79 m, 77 m), and St George's Respiratory Questionnaire score (total score=−5.9 U, −2.2 U) were observed. Quantitative analysis of computed tomography imaging demonstrated a 357 mL reduction in RUL lung volume, and corresponding increases in volumes of adjacent, less damaged areas of lung tissue. Conclusions BLVR produced effective targeted lung volume reduction of a RUL bullous and improvements in spirometry, symptoms, exercise capacity, and diffusing capacity. This novel bronchoscopic technique may provide a safe alterative to bullectomy in selected patients.