TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality within the United States. Bronchoscopic lung volume reduction (BLVR) targets emphysematous lobes to reduce lung hyperinflation and improve patient symptoms. Both Zephyr Endobronchial Valves and the Spiration Valve System were evaluated and approved for single lobe, targeted BLVR in the treatment of emphysema [1-3]. To date, there are no clinical comparative trials between the two systems, and little is known regarding their interchangeability. We present a case of persistent cough following BLVR with resolution after exchange of endobronchial valves. CASE PRESENTATION: A 60 year old female, former smoker, with stage III, oxygen dependent COPD (FEV1 33%) underwent evaluation and placement of Zephyr valves for BLVR. Past medical history notable for stage I sarcoidosis. No known allergies to nickel, silicone, or plastic. A total of seven Zephyr valves were used for successful left lower lobe occlusion. At two months, she had stable PFTs (FEV1 39%) with subjective improvement in dyspnea. However, patient developed persistent dry, non-productive cough. She was treated with multiple courses of prednisone with improvement, and ultimately became steroid dependent. Bronchoscopy demonstrated well-seated valves with significant granulation tissue, and areas of partial obstruction. All seven valves were removed and steroids discontinued with subsequent improvement in cough, though return of dyspnea to baseline. After six months, patient again underwent BLVR with Spiration valve placement. A total of six Spiration valves were used for left lower lobe occlusion. She again reported subjective improvement in dyspnea with stable PFTs (FEV1 36%), though without return of cough at 6 month follow-up. DISCUSSION: Adverse events following BLVR are well-documented with both Zephyr and Spiration valves with pneumothorax being the most significant. However, patients do develop more subtle reactions including increased dyspnea, hypoxemia, and cough [1-3]. Results from the TRANSFORM trial document that 6.2% of patients develop cough following Zephyr endobronchial valve placement, and may contribute to patient morbidity as described above, though data regarding the management of valve intolerance is lacking [1]. In cases of symptomatic bronchial irritation secondary to valve placement as described above, patients may benefit from valve exchange. CONCLUSIONS: Here we illustrate a case of cough due to tissue granulation following endobronchial valve placement with resolution after valve exchange with an alternate manufacturer. Valve exchange may provide symptomatic relief while preserving BLVR benefits in select patients. REFERENCE #1: Kemp, S.V., et al., A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (TRANSFORM). Am J Respir Crit Care Med, 2017. 196(12): p. 1535-1543. REFERENCE #2: Criner, G.J., et al., A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med, 2018. 198(9): p. 1151-1164. REFERENCE #3: 3. Criner, G.J., et al., Improving Lung Function in Severe Heterogenous Emphysema with the Spiration Valve System (EMPROVE). A Multicenter, Open-Label Randomized Controlled Clinical Trial. Am J Respir Crit Care Med, 2019. 200(11): p. 1354-1362. DISCLOSURES: No relevant relationships by Raed Alalawi, source=Web Response No relevant relationships by Lisa Jarnagin, source=Web Response