Springing forward to medium-term results for endobronchial coils for emphysema

Endoscopic lung volume reduction coil treatment in patients with very low FEV1: an observational study

BACKGROUND

Endoscopic lung volume reduction coil (LVRC) treatment is a therapeutic option for selected patients with advanced emphysema. The effects and the safety of endoscopic lung volume reduction in patients with very low forced expired volume in one second (FEV₁) remain to be determined. This study was conducted to assess the effects and the safety of LVRC treatment in patients with very low FEV₁.

METHODS

The study was performed as a retrospective observational study in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf on patients with very low FEV₁, defined as an FEV₁ ⩽ 20% of predicted at baseline in whom LVRC treatment was performed between 1 April 2012 and 28 February 2017.

RESULTS

LVRC treatment was performed in 33 patients with very low FEV₁. Of these, 45.5% were female and 54.5% were male. At baseline, mean FEV₁ was 0.46 ± 0.12 liters (15 ± 3% of predicted), mean forced vital capacity (FVC) was 1.61 ± 0.62 liters (42 ± 13% of predicted), mean residual volume (RV) was 6.03 ± 0.81 liters (275 ± 51% of predicted) and 6-minute walk distance was 229 ± 102 m. Bilateral LVRC treatment was completed in 21 of these patients (63.6%). Bilateral LVRC treatment led to significant improvements in functional parameters with an increase in mean FEV₁ from 0.44 ± 0.11 liters to 0.54 ± 0.12 liters ( p = 0.001), equivalent to a relative improvement of 24.5 ± 26.9%, an increase in mean FVC from 1.49 ± 0.54 liters to 1.84 ± 0.49 liters ( p = 0.001), a decrease in mean RV from 6.27 ± 0.83 liters to 5.83 ± 1.09 liters ( p = 0.004) and an improvement in 6-minute walk distance from 218 ± 91 m to 266 ± 96 m ( p = 0.01). There were no cases of respiratory failure requiring mechanical ventilation and no deaths.

CONCLUSIONS

LVRC treatment was effective and safe in patients with very low FEV₁.

Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study

Background:

Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. In the advanced stages, emphysema leads to respiratory failure: hypoxemia and eventually chronic hypercapnic respiratory failure. It can be hypothesized that LVRC treatment, a procedure targeting hyperinflation and thereby reducing ventilatory workload, may be especially beneficial in patients with chronic hypercapnic respiratory failure. This study was conducted to gain first insights into the effects and the safety of LVRC treatment in patients with emphysema and chronic hypercapnic respiratory failure.

Methods:

A retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf, Germany on all patients with chronic hypercapnic respiratory failure in whom bilateral LVRC treatment was performed between 1 April 2012 and 30 September 2015.

Results:

During the study period, bilateral LVRC treatment was performed in 10 patients with chronic hypercapnic respiratory failure. Compared with baseline, bilateral LVRC treatment led to a significant increase in mean forced expiratory volume in one second (FEV₁) from 0.5 ± 0.1 l to 0.6 ± 0.2 l (p = 0.004), a decrease in residual volume (RV) from 6.1 ± 0.9 l to 5.6 ± 1.1 l (p = 0.02) and a reduction in partial pressure of carbon dioxide in arterial blood (PaCO₂) from 53 ± 5 mmHg to 48 ± 4 mmHg (p = 0.03). One case of hemoptysis requiring readmission to hospital was the only severe adverse event.

Conclusions:

LVRC treatment was safe and effective in patients with nonsevere chronic hypercapnic respiratory failure. It led not only to an improvement in lung function but also to a significant decrease in PaCO₂.