Bronchoscopic Volume Reduction Research Articles

Endobronchial coil lung volume reduction performed on patients with emphysema dominant COPD: Long term follow-up results.

Chronic obstructive pulmonary disease (COPD) is a commonly seen, preventable, and treatable disease with permanent respiratory symptoms and air entrapment that is caused by particle exposure. In case of limited response to traditional treatment protocols, lung volume reduction may be performed in patients with emphysema dominant patterns. In this study, long term follow-up results of the patients who had been operated on by minimal invasive bronchoscopic lung volume reduction surgery by coil placement were reported. Records of the patients operated on by coil placement were retrospectively investigated, and pulmonary function test (PFT), echocardiography (ECHO), six-minute walking test (6MWT), tomography images, ventilation scintigraphy, and clinical summaries were evaluated. Out of 34 initial candidates, 18 patients were included in the study. Wilcoxon signed-rank test and Spearman's rho were utilized to compare interventions and follow-up testing. The average age of 18 patients was 62 (50-74) years, and except for one patient, all were males (n= 17). Fifteen patients were operated bilaterally, and the rest were unilaterally operated, with an average of 10 coils placed per coil placement. An average of 90 days was between bronchoscopic coil placement, with a follow-up duration of 45 days in between. Mean total follow-up duration was 794 (± 424) days. Pneumonia and pneumonitis were seen in 33% of patients within the first month. Mortality from respiratory causes was found to be 11%, while mortality from all causes was found to be 22%. Statistical difference was observed regarding 6MWT after bronchoscopic volume reduction when compared the initial preoperative values. However, this difference was later lost statistically at the second follow-up performed after the completion of both sides. A benefit in improved resting saturation was observed after the second procedure, which was not evident after unilateral intervention. However, similiar to 6MWT, this benefit was lost at the second follow-up, with resting saturation instead being effected negatively. No difference was observed in PFT results; however, a correlation was seen between FEV1 and walking distance. No specific correlation had been seen in the ECHO evaluation. Benefits regarding 6MWT and resting saturation were observed in patients undergoing minimal invasive bronchoscopic lung volume reduction surgery with coils. This benefit was evident in the short term but was lost as the follow-up duration increased. A relatively high morbidity and mortality rate was also present, further stating the risky nature of pulmonary intervention, even minimally invasive procedures, on patients with COPD.

Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema.

In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema. The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient's records, including the modified Medical Research Council (MRC) dyspnea score, the St. George's Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated. Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month's mMRC score was 2.62 (p=0.007), and the mean of the 12th month's mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients' preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients' preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756). It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

A retrospective evaluation of the pulmonary function tests and quality of life assessment surveys of emphysema patients subject to coil treatment.

Bronchoscopic volume reduction treatments are among the important alternatives for selected emphysema patients with a dyspneic course despite optimal medical treatment. Our aim was to carry out a retrospective scan of the data for COPD patients subject to coil treatment at our center for assessing whether coil procedure has an impact on the respiratory symptom and pulmonary function tests in COPD patients. The data of 41 patients with severe emphysema and treated with coils between 2017-2020 were evaluated retrospectively. Cardiopulmonary rehabilitation programs were completed for all patients prior to the procedure and they were assessed with pulmonary function test (PFT), diffusing capacity for carbonmonoxide test (DLCO), body plethysmography, 6-minute walk test, ventilation/perfusion scintigraphy, St. George's Respiratory Questionnaire (SGRQ). Data acquired prior to the procedure and 3rd month control data after the procedure were recorded and SGRQ was applied via face-to-face interviews during the controls by doctors working on Pulmonary Diseases as was the case before the procedure. SGRQ questionnaires of 32 patients were evaluated. Statistically significant changes were observed after the procedure in symptom, activity, impact score and total score which were calculated prior to the procedure. Pre and post procedure FEV1, FVC, FEV1/FVC, PEF, FEF25/75 parameters were used for the comparison made via SFT. Statistically significant changes were observed in FEV1, FVC, FEF25/75 when the pre and post-procedure SFT parameters of the 32 patients included in the study were compared. A statistically significant improvement was observed in the PFT parameters and quality of life questionnaires following the coil procedure which is a bronchoscopic volume reduction procedure.

Endobronchial valve treatment of persistent alveolopleural fistulae in a patient with cystic fibrosis and empyema

Persistent air leak (PAL) is a common problem after secondary pneumothorax due to cystic fibrosis (CF). These leaks, caused by either bronchopleural or alveolopleural fistula, are associated with higher morbidity and mortality [1]. Air leaks are traditionally treated with chronic chest tube drainage, chemical pleurodesis, or autologous blood patching in non-surgical candidates [1]. However, these strategies can increase infectious risk or pleural scarring, which are associated with poorer lung transplant surgical outcomes. Endobronchial valve (EBV) placement, while FDA-approved for use in both some surgical PALs and bronchoscopic volume reduction therapy, is one alternative option, but it could theoretically increase the risk of infection, especially in CF patients. Here, we report the case of a CF patient under evaluation for lung transplant who received EBVs for PAL after bilateral secondary spontaneous pneumothoraces.

A Review of Surgical Managements of Chronic Obstructive Pulmonary Disease

Medical and non-pharmacological treatments continue to be the initial managements for chronic obstructive pulmonary disease (COPD). These managements have evolved over time, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the long-term decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life. Optimal management for patients with COPD requires both pharmacologic and non-pharmacologic managements. To date, the only treatments that can modify the course of COPD and potentially cure the disease are surgical treatments. Some of the surgical managements we discussed in this review include Lung Volume Reduction Surgeries (LVRS), Bronchoscopic Volume Reduction Surgery (BVRS), bullectomy and lung transplants. The indications for these surgical managements have also been discussed in this article. Patients for surgical managements have to be appropriately selected to avoid some of the major adverse events that can occur because of some of the treatment modality.

Are Bronchoscopic Volume Reduction Treatments Benefical in E Mphysema?

Are Bronchoscopic Volume Reduction Treatments Benefical in E Mphysema?

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema.

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for severe emphysema, providing treatment options for patients who are unable to undergo lung volume reduction surgery (LVRS) or lung transplantation. Current BLVR techniques include bronchoscopic volume reduction with valve implants, use of a lung volume reduction coil (LVRC), bronchoscopic thermal vapor ablation (BTVA), biological lung volume reduction (BioLVR), and use of airway bypass stents (ABS). To date, several randomized controlled trials of these bronchoscopic therapies have been conducted in patients with emphysema, and bronchoscopic volume reduction with valve implants remains the best approach thus far. Recent studies indicate that BLVR may be of great value in improving lung function, exercise capacity, and quality of life and that BLVR has the potential to replace conventional surgery for patients with severe emphysema. Optimal patient selection and the proper selection of the BLVR technique in accordance with patient characteristics are crucial to the success of BLVR. More multicenter, prospective, randomized controlled trials need to be conducted in the future to optimize the current selection strategy and evaluate the safety, efficiency, and long-term benefit of BLVR techniques.

Recent Advances in Dyspnea

Dyspnea is the most prevalent symptom among patients with cardiac and respiratory diseases. It is an independent predictor of mortality in patients with heart disease, COPD, and the elderly. Studies using naloxone to block opioid-receptor signaling demonstrate that endogenous opioids modulate dyspnea in patients with COPD. Neuroimaging studies support a cortical-limbic network for dyspnea perception. A 2012 American Thoracic Society statement recommended that dyspnea be considered across three different constructs: sensory (intensity), affective (distress), and impact on daily activities. The 2013 GOLD (Global Initiative for Chronic Obstructive Lung Disease) executive summary recommended a treatment paradigm for patients with COPD based on the modified Medical Research Council dyspnea score. The intensity and quality of dyspnea during exercise in patients with COPD is influenced by the time to onset of critical mechanical volume constraints that are ultimately dictated by the magnitude of resting inspiratory capacity. Long-acting bronchodilators, either singly or in combination, provide sustained bronchodilation and lung deflation that contribute to relief of dyspnea in those with COPD. Opioid medications reduce breathing discomfort by decreasing respiratory drive (and associated corollary discharge), altering central perception, and/or decreasing anxiety. For individuals suffering from refractory dyspnea, a low dose of an opioid is recommended initially, and then titrated to achieve the lowest effective dose based on patient ratings. Acupuncture, bronchoscopic volume reduction, and noninvasive open ventilation are experimental approaches shown to ameliorate dyspnea in patients with COPD, but require confirmatory evidence before clinical use.

Bronchoscopic volume reduction in severe emphysema

For the past decade, volume reduction surgical intervention has been adopted for the management of end-stage emphysematous lung diseases, as an alternative to medical treatment. Within the same purpose, endobronchial volume reduction surgery has been used recently for the patients who are not eligible for surgery. In this article, we present a 55-year-old male patient with a significant bilateral lower lobe emphysematous lung disease accompanied by a forced expiratory volume in one second (FEV1) value of 0.47 lt (13%). He underwent bronchoscopic occlusion of segmental and subsegmental bronchial occlusion using nine “Endobronchial Watanabe Spigot’s” through rigid bronchoscope. After six months of follow-up, FEV1 value was estimated as 0.74 lt (21%), which was nearly twofold increase compared to preoperative levels. Total lung capacity and residual volume was reduced to 9.2 lt (102%) and 4.2 lt (150%), respectively. This minimal invasive endobronchial methods may be effective in patients who are in the waiting list of transplantation or ineligible candidates for surgery.

Endobronchial valve deployment in severe α‐1 antitrypsin deficiency emphysema: a case series

Patients with end-stage emphysema because of α-1 antitrypsin (AAT) deficiency represent a challenging clinical management problem, and studies of volume reduction therapy to date have largely excluded these patients. We report the outcome of bronchoscopic volume reduction with the insertion of Emphasys endobronchial valves (Emphasys Medical, Redwood City, CA, USA) in six patients with end-stage emphysema because of AAT deficiency. Of 51 patients with end stage emphysema referred for transplantation, we studied six patients with AAT deficiency and utilized the BODE index and lung allocation score for survival estimation. The forced expiratory volume in 1s improved from a median of 0.575L to 0.905L (P=0.028). There was a median reduction in total lung capacity (TLC) of 0.61L. The residual volume /TLC fell from 74.0% to 58.4%. Before treatment, four patients had a BODE index of greater than eight units, which correlates with a 4-year survival of 18%. After treatment, two patients improved their BODE index to below seven units, which correlates with an estimated 4-year survival of over 50%. The data from this case series suggest that this intervention may provide bridging therapy to subsequent transplantation for younger AAT patients with end-stage emphysema.

Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe. The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman's rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes. The target lobe volume at full inspiration in the treatment group had a mean reduction of -0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = -0.68, P < 0.0001) and contralateral lung (rho = -0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03). When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung. Computed tomography allows assessment of the treatment of emphysema with endobronchial valves. • Endobronchial valves can reduce the volume of an emphysematous lung lobe. • Compensatory expansion is greater in ipsilateral lobes than in the contralateral lung. • Reduced air trapping is measurable by RV/TLC and smaller low attenuation area.

Respiratory Review of 2012: Bronchoscopic Innovations and Advances

Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.

A potential role for endobronchial valves in patients with lung transplant

Native lung hyperinflation (NLH) is a unique condition seen in emphysema patients after single-lung transplant (SLT). The overinflated native lung acts to extrinsically restrict the transplanted lung, impairing graft function. NLH has been treated with surgical lung volume reduction (LVR), 1 Anderson M.B. Kriet J.M. Kapelanski D.P. et al. Volume reduction surgery in the native lung after single lung transplantation for emphysema. J Heart Lung Transplant. 1997; 16: 752-757 PubMed Google Scholar but at the risk of major morbidity and even death. The risk of peri-operative infection is increased in the heavily immunosuppressed patient, and some anti-rejection medications seriously impair wound healing. Recent work with one-way endobronchial valves (EBVs) for the treatment of emphysema has allowed the possibility of LVR without the need for surgery. 2 Toma T.P. Hopkinson N.S. Hillier J. et al. Bronchoscopic volume reduction with valve implants in patients with severe emphysema. Lancet. 2003; 361: 931-933 Abstract Full Text Full Text PDF PubMed Scopus (281) Google Scholar , 3 Endobronchial Valves for Emphysema palliatioN Trial (VENT) preliminary results report. Presented at the European Respiratory Society 17th Annual Congress, Stockholm, Sweden, Sept 20, 2007. Google Scholar The literature on EBV use in NLH is restricted to a single case report in acute NLH, 4 Crespo M.M. Johnson B.A. McCurry K.R. et al. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema. Chest. 2007; 131: 214-216 Crossref PubMed Scopus (15) Google Scholar and to date there are no published data on EBV use in chronic NLH.

Collateral Ventilation, the Bane of Bronchoscopic Volume Reduction

Collateral Ventilation, the Bane of Bronchoscopic Volume Reduction

Bronchoscopic Volume Reduction with Valve Implants in Patients with Severe Emphysema

Bronchoscopic Volume Reduction with Valve Implants in Patients with Severe Emphysema

Bronchoscopic volume reduction with valve implants in patients with severe emphysema.

Eight patients with severe emphysema entered a pilot study of unilateral volume reduction by endobronchial valve insertion. Five patients had emphysema judged too severe for volume reduction surgery and three refused the operation. After valve insertions, the median forced expiratory volume in 1 s (FEV1) increased from 0.79 L (range 0.61-1.07) to 1.06 L (0.75-1.22) (difference 34%, p=0.028) and the median diffusing capacity (TL(CO)) increased from 3.05 mL/min/mm Hg (2.35-4.71) to 3.92 mL/min/mm Hg (2.89-5.40) (difference 29%, p=0.017). CT scans showed a substantial reduction in regional volume in four of the eight patients. Two patients developed a transient pneumothorax (one requiring drainage) but we recorded no other important adverse effects during follow-up. Lung-volume reduction can be achieved with unilateral bronchoscopically placed valve implants in patients with severe emphysema with acceptable short-term safety and worthwhile functional benefits.

Bronchoscopic volume reduction. A safe and effective alternative to surgical therapy for emphysema.

Bronchoscopic volume reduction. A safe and effective alternative to surgical therapy for emphysema.