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Everaerts S, Vandervelde CM, Shah P, Slebos DJ, Ceulemans LJ. Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema. Eur Respir Rev 2023; 32:230004. [PMID: 38123230 PMCID: PMC10731473 DOI: 10.1183/16000617.0004-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/17/2023] [Indexed: 12/23/2023] Open
Abstract
COPD is a highly prevalent, chronic and irreversible obstructive airway disease without curative treatment. Standard therapeutic strategies, both non-pharmacological and pharmacological, have only limited effects on lung function parameters of patients with severe disease. Despite optimal pharmacological treatment, many patients with severe COPD still have a high burden of dyspnoea and a poor quality of life. If these patients have severe lung emphysema, with hyperinflation as the driver of symptoms and exercise intolerance, lung volume reduction may be an effective treatment with a significant impact on lung function, exercise capacity and quality of life. Currently, different lung volume reduction approaches, both surgical and bronchoscopic, have shown encouraging results and have been implemented in COPD treatment recommendations. Nevertheless, choosing the optimal lung volume reduction strategy for an individual patient remains challenging. Moreover, there is still room for improving durability of effect and safety in all available procedures. Ongoing and innovative research is essential to push this field forwards. This review provides an overview of results and limitations of the current lung volume reduction options for patients with severe lung emphysema and hyperinflation.
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Affiliation(s)
- Stephanie Everaerts
- Department of Pulmonary Diseases, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Christelle M. Vandervelde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pallav Shah
- Department of Pulmonology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Pulmonology, Chelsea and Westminster Hospital, London, UK
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Both authors contributed equally
| | - Laurens J. Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Both authors contributed equally
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Kayikci H, Cimen P, Katgi N. Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:506-512. [PMID: 38268657 PMCID: PMC10805047 DOI: 10.14744/semb.2023.06767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/22/2023] [Accepted: 09/07/2023] [Indexed: 01/26/2024]
Abstract
Objectives 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. Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Hazal Kayikci
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Pinar Cimen
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Nuran Katgi
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
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Mang S, Huss N, Schäfers HJ, Wehrfritz H, Massmann A, Lensch C, Langer F, Seiler F, Bals R, Lepper PM. Endoscopic lung volume reduction coils for patients with severe emphysema-a single-centre retrospective analysis. Interact Cardiovasc Thorac Surg 2021; 33:402-408. [PMID: 33961051 DOI: 10.1093/icvts/ivab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema. METHODS From September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6-12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort. RESULTS While coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity -2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment. CONCLUSIONS ELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.
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Affiliation(s)
- Sebastian Mang
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Niklas Huss
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Hans-Joachim Schäfers
- Saarland University, Saarbrücken, Germany.,Department of Thoracic- and Cardiovascular Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Holger Wehrfritz
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Alexander Massmann
- Saarland University, Saarbrücken, Germany.,Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Christian Lensch
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Frank Langer
- Saarland University, Saarbrücken, Germany.,Department of Thoracic- and Cardiovascular Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Frederik Seiler
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Robert Bals
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
| | - Philipp M Lepper
- Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany.,Saarland University, Saarbrücken, Germany
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Dumanli A, Metin B, Gunay E. Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey. Ann Saudi Med 2020; 40:469-476. [PMID: 33307740 PMCID: PMC7733646 DOI: 10.5144/0256-4947.2020.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/25/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES Compare our experience with valve and coil BLVR devices. DESIGN Retrospective. SETTING Single tertiary care centre. PATIENTS AND METHODS Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES Change in PFTs and completion of the 6MWT. SAMPLE SIZE 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ahmet Dumanli
- From the Department of Chest Surgery, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Bayram Metin
- From the Department of Chest Surgery, Acibadem Hospitals Group, Kayseri, Turkey
| | - Ersin Gunay
- From the Department of Pulmonology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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