Efficacy Of Bronchoscopic Lung Volume Reduction Research Articles

Utility of rehabilitation prior to bronchoscopic lung volume reduction: post hoc analysis of the VENT trial.

Rehabilitation programmes are a valuable treatment modality for patients with COPD to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation prior to bronchoscopic lung volume reduction (BLVR) is unclear. We performed a post hoc analysis of the Valve for Emphysema Palliation Trial (VENT) trial, the first multicentre randomised trial comparing the safety and efficacy of BLVR. Patients completed a pulmonary rehabilitation programme prior to BLVR over 6-10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (6-min walk distance (6MWD)) were assessed before and after rehabilitation and we tried to identify predictors for pulmonary rehabilitation benefit. Lung function and exercise capacity of 403 patients (mean±sd age 63.3±7.4 years, 37.5% female, mean±sd forced expiratory volume in 1 s 30.1±7.6 L) were analysed. Exercise capacity significantly improved from 331.6±98.8 m to 345.6±95.3 m (p<0.001) in 6-min walk testing (6MWT), with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnoea after 6MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6MWD <250 m) benefited more from pulmonary rehabilitation. The indication and prerequisites for BLVR were still present in all patients after pulmonary rehabilitation. The national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.

Bronchoscopic lung volume reduction by histoacryl

Background Lung volume reduction can be accomplished by bronchoscopy, a procedure that represents a potential alternative to lung volume reduction surgery. The initial physical approach to bronchoscopic lung volume reduction (BLVR) was based on the simple concept that collapse of target regions could be initiated using a washout solution to disrupt the surfactant function and be maintained with a biocompatible ‘tissue sealant’ to prevent re-expansion. Aim The aim was to evaluate the safety and efficacy of BLVR using an adhesive material (histoacryl blue glue) in patients with emphysema and emphysematous bullae. Settings and design Prospective interventional analysis from two centers’ registry, namely The Bronchology Unit at Chest Department, Ain Shams University and The Bronchoscopy Unit of Kobry El Kobba Military Chest Hospital. Patients and methods The study included 40 patients having emphysema. All the patients had spirometry, arterial blood gases, 6 min walking test, and body plethysmography. All these tests were performed before and 90 days after the procedure. Results Residual volume decreased by 15.30% (P=0.567), forced expiratory volume in the first second increased by 11.43% (P=0.088), forced vital capacity increased by 22.92% (P=0.007), and 6-min walking distance increased by 70.39% (P=0.021). Postprocedure complications were minor with no mortality. Conclusion BLVR therapy using histoacryl blue glue is well tolerated and safe in patients with emphysematous bulla and diffuse emphysema. Treatment is associated with modest improvement in pulmonary function test values, increased exercise performance, and reduced dyspnea.

Review of lung sealant technologies for lung volume reduction in pulmonary disease.

Emphysema is an incurable and underdiagnosed disease with obstructive ventilatory impairment of lung function. Despite decades of research, medical treatments available so far did not significantly improve the survival benefits. Different bronchoscopic methods for lung volume reduction (LVR) in emphysema were used in the past 2 decades aiming to close the airways serving the hyperinflated lung regions and to allow the gas in the more distal bullas to be absorbed. Sealants and adhesives can be natural/biological, synthetic and semisynthetic. In lung surgery, lung sealants are used to treat prolonged air leak, which is the most common complication. Sealants can also be applied in bronchoscopic lung volume reduction (BLVR) as they administer into the peripheral airways where they polymerize and act as tissue glue on the surface of the lung to seal the target area to cause durable permanent absorption atelectasis. Initial studies analyzed the efficacy of bronchoscopic instillation of a fibrinogen–thrombin complex solution in advanced emphysema. Future studies will analyze the effects of adding chondroitin sulfate and poly-L-lysine to thrombin–fibrinogen complex thus promoting fibroblast attachment, proliferation and scarring, causing bronchial fibrostenosis and preventing ventilation of the affected part of the lung. Modifications of these methods were later developed, and the efficacy of BLVR with other sealants was analyzed in clinical studies. Results from current studies using this treatment method are promising showing that it is effective in improving exercise tolerance and quality of life in patients with advanced emphysema. It seems that subjective benefits in dyspnea scores and quality of life are more marked than improvements in lung function tests. The safety profile of sealant techniques in BLVR was mostly acceptable in clinical studies. The definite conclusions about the effectiveness of sealant in BLVR could be difficult because only a small population was involved in the current studies. More randomized large controlled studies are needed in establishing the definite role of biological BLVR in the bronchoscopic treatment of emphysema.

Bronchoscopic lung volume reduction (BLVR) using bronchial prostheses: a pilot safety and efficacy study

Lung volume reduction surgery(LVRS) can provide symptomatic improvement in patients with advanced emphysema. Both the open and video-assisted approaches to LVRS are associated with significant morbidity and mortality. Selective bronchoscopic placement of prostheses into segmental bronchi has the potential to achieve LVRS by promoting absorption atelectasis without an incision or intercostal drainage. Aim: this phase 1 study reports the safety and efficacy of BLVR. Methods: following successful sheep experiments, patients with apical emphysema and hyperinflation (otherwise acceptable for standard approach LVR) had apical bronchoscopic segmental airway placement of one-way valves under general anesthesia. The 4 or 6mm valves were silicone based and mounted in a Nitinol bronchial stent (Emphasys Medical Inc, CA, USA). Placement was over a guidewire under bronchoscopic and fluoroscopic control. Results: 5 patients(2M,3F, age 57-69yrs)underwent BLVR. Mean preoperative FEV1 was 0.72L(0.38-1.02L, 23-34% predicted)with a 6minute walk of 354m(315-402m).6-11 prostheses per patient took 90-135 minutes to obstruct most or all upper lobe segments bilaterally. Inpatient stay was 2-8 days. Relatively minor complications seen include minor exacerabtion of COPD(n 3), hemoptysis, pneumothorax(managed with aspiration only) and lower lobe pneumonia(n 1 for each). Symptomatic improvement is noted in 3 of 5 and the other 2 are currently stable. At 1 month lung function is unchanged in 4 patients and imaging shows collapse in only 1 patient. Conclusion: BLVR is a potentially useful novel therapy for emphysema. This pilot study shows that BLVR protheses can be safely placed into the human lung. The absence of xray lung reduction or spirometric improvement likely indicates significant collateral ventilation is occurring, possibly from previously undescribed interlobar collaterals. Alternatively, valve leakage remains possible. Extended followup studies, with active attempts to collapse the obstructed segments are pending.