Skip to main content

Advertisement

SpringerLink
Log in

Early Trends in Bronchoscopic Lung Volume Reduction: A Systematic Review and Meta-analysis of Efficacy Parameters

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Introduction

The goal of our systematic review and meta-analysis is to examine the therapeutic effectiveness of bronchoscopic lung volume reduction (BLVR), and to compare it with medical management and lung volume reduction surgery.

Methods

Variables of interest were absolute change in FEV1, 6MWT, and SGRQ. Meta-analysis was performed for the BLVR modalities with ≥3 trials. Of the 18 shortlisted publications, only valves (four trials; n = 159) and coils (six trials; n = 194) qualified for meta-analysis. To avoid redundant reporting for valves, only the data for intact fissure subjects were analyzed. Outcome data are presented as the mean difference from baseline with 95% confidence interval at 6-months follow-up.

Results

For BLVR using valves, the pooled mean difference (PMD) for FEV1 was 0.146 L (95% CI 0.111–0.181; p < 0.001), 6MWT was 45.225 meters (95% CI 26.954–63.495; p < 0.001), and SGRQ was −8.825 points (95% CI −14.824 to −2.825; p = 0.004). All the PMDs were statistically significant and higher than their respective minimal clinically important difference (MCID). For BLVR using coils, the PMD for FEV1 was 0.080 L (95% CI 0.057–0.104; p < 0.001), 6MWT was 45.320 meters (95% CI 28.040–62.600; p < 0.001), and SGRQ was −10.570 points (95% CI −13.299 to −7.841; p < 0.001). All three variables showed statistically significant PMDs but that for FEV1 was smaller than the MCID. Data from BLVR modalities with <3 major publications are reviewed in the discussion section.

Conclusions

BLVR offers early promise in the palliation of advanced emphysema. Better characterization of patients to identify phenotypes that will derive sustained benefit is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mathers BM, Degenhardt L, Phillips B et al (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 372(9651):1733–1745

    Article  PubMed  Google Scholar 

  2. Mannino DM, Homa DM, Akinbami LJ et al (2002) Chronic obstructive pulmonary disease surveillance–United States, 1971–2000. Respir Care 47(10):1184–1199

    PubMed  Google Scholar 

  3. Fishman A, Martinez F, Naunheim K et al (2003) A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 348(21):2059–2073

    Article  PubMed  Google Scholar 

  4. Ahmad S, Taneja A, Kurman J et al (2014) National trends in lung volume reduction surgery in the United States: 2000 to 2010. Chest 146(6):e228–e229

    Article  PubMed  Google Scholar 

  5. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012

    Article  PubMed  Google Scholar 

  6. Sciurba FC, Ernst A, Herth FJ et al (2010) A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 363(13):1233–1244

    Article  CAS  PubMed  Google Scholar 

  7. Herth FJ, Noppen M, Valipour A et al (2012) Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort. Eur Respir J 39(6):1334–1342

    Article  PubMed  Google Scholar 

  8. Venuta F, Anile M, Diso D et al (2012) Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J 39(5):1084–1089

    Article  PubMed  Google Scholar 

  9. Donohue JF (2005) Minimal clinically important differences in COPD lung function. COPD 2(1):111–124

    Article  PubMed  Google Scholar 

  10. Puhan MA, Chandra D, Mosenifar Z et al (2011) The minimal important difference of exercise tests in severe COPD. Eur Respir J 37(4):784–790

    Article  CAS  PubMed  Google Scholar 

  11. Jones PW (2005) St. George’s respiratory questionnaire: MCID. COPD 2(1):75–79

    Article  PubMed  Google Scholar 

  12. Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sciurba FC, Ernst A, Herth FJ et al (2010) A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 363(13):1233–1244

    Article  CAS  PubMed  Google Scholar 

  14. Klooster K, ten Hacken NH, Hartman JE et al (2015) Endobronchial valves for emphysema without interlobar collateral ventilation. N Engl J Med 373(24):2325–2335

    Article  CAS  PubMed  Google Scholar 

  15. Deslee G, Klooster K, Hetzel M et al (2014) Lung volume reduction coil treatment for patients with severe emphysema: a European multicentre trial. Thorax 69(11):980–986

    Article  PubMed  PubMed Central  Google Scholar 

  16. Deslee G, Mal H, Dutau H et al (2016) Lung volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical trial. JAMA 315(2):175–184

    Article  CAS  PubMed  Google Scholar 

  17. Klooster K, Ten Hacken NH, Franz I et al (2014) Lung volume reduction coil treatment in chronic obstructive pulmonary disease patients with homogeneous emphysema: a prospective feasibility trial. Respiration 88(2):116–125

    Article  PubMed  Google Scholar 

  18. Kontogianni K, Gerovasili V, Gompelmann D et al (2014) Effectiveness of endobronchial coil treatment for lung volume reduction in patients with severe heterogeneous emphysema and bilateral incomplete fissures: a six-month follow-up. Respiration 88(1):52–60

    Article  PubMed  Google Scholar 

  19. Slebos DJ, Klooster K, Ernst A et al (2012) Bronchoscopic lung volume reduction coil treatment of patients with severe heterogeneous emphysema. Chest 142(3):574–582

    Article  PubMed  Google Scholar 

  20. Zoumot Z, Kemp SV, Singh S et al (2015) Endobronchial coils for severe emphysema are effective up to 12 months following treatment: medium term and cross-over results from a randomised controlled trial. PLoS ONE 10(4):e0122656

    Article  PubMed  PubMed Central  Google Scholar 

  21. Criner GJ, Pinto-Plata V, Strange C et al (2009) Biologic lung volume reduction in advanced upper lobe emphysema: phase 2 results. Am J Respir Crit Care Med 179(9):791–798

    Article  PubMed  Google Scholar 

  22. Herth FJ, Gompelmann D, Stanzel F et al (2011) Treatment of advanced emphysema with emphysematous lung sealant (AeriSeal(R)). Respiration 82(1):36–45

    Article  CAS  PubMed  Google Scholar 

  23. Kramer MR, Refaely Y, Maimon N et al (2013) Two-year follow-up in patients treated with emphysematous lung sealant for advanced emphysema. Chest 144(5):1677–1680

    Article  PubMed  Google Scholar 

  24. Refaely Y, Dransfield M, Kramer MR et al (2010) Biologic lung volume reduction therapy for advanced homogeneous emphysema. Eur Respir J 36(1):20–27

    Article  CAS  PubMed  Google Scholar 

  25. Herth FJ, Ernst A, Baker KM et al (2012) Characterization of outcomes 1 year after endoscopic thermal vapor ablation for patients with heterogeneous emphysema. Int J Chron Obstr Pulm Dis 7:397–405

    Google Scholar 

  26. Herth FJ, Valipour A, Shah PL et al (2016) Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial. Lancet Respir Med 4(3):185–193

    Article  PubMed  Google Scholar 

  27. Song L, Zhao F, Ti X et al (2013) Bronchoscopic lung volume reduction for pulmonary emphysema: preliminary experience with endobronchial occluder. Respir Care 58(8):1351–1359

    Article  PubMed  Google Scholar 

  28. Shah P, Slebos D, Cardoso P et al (2011) Bronchoscopic lung-volume reduction with exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial. Lancet 378(9795):997–1005

    Article  CAS  PubMed  Google Scholar 

  29. Springmeyer SC, Bolliger CT, Waddell TK et al (2009) Treatment of heterogeneous emphysema using the spiration IBV valves. Thorac Surg Clin 19(2):247–253

    Article  PubMed  Google Scholar 

  30. Venuta F, Anile M, Diso D et al (2012) Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J 39(5):1084–1089

    Article  PubMed  Google Scholar 

  31. Zoumot Z, Kemp SV, Singh S et al (2015) Endobronchial coils for severe emphysema are effective up to 12 months following treatment: medium term and cross-over results from a randomised controlled trial. PloS ONE 10(4):e0122656

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ninane V, Geltner C, Bezzi M et al (2012) Multicentre European study for the treatment of advanced emphysema with bronchial valves. Eur Respir J 39(6):1319–1325

    Article  PubMed  Google Scholar 

  33. Sciurba FC, Criner GJ, Strange C et al (2016) Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema: the RENEW randomized clinical trial. JAMA 315(20):2178–2189

    Article  CAS  PubMed  Google Scholar 

  34. Come C, Abu-Hijleh M, Berkowitz D, Bezzi M et al (2014) Results of the ASPIRE endoscopic lung volume reduction trial at study termination. Eur Respir J 44(58):P3717

    Google Scholar 

  35. Iftikhar IH, McGuire FR, Musani AI (2014) Efficacy of bronchoscopic lung volume reduction: a meta-analysis. Int J Chron Obstr Pulm Dis 9:481–491

    Article  Google Scholar 

  36. Slebos D-J, Hartman JE, Klooster K et al (2015) Bronchoscopic coil treatment for patients with severe emphysema: a meta-analysis. Respiration 90(2):136–145

    Article  PubMed  Google Scholar 

  37. Hopkinson NS, Kemp SV, Toma TP et al (2011) Atelectasis and survival after bronchoscopic lung volume reduction for COPD. Eur Respir J 37(6):1346–1351

    Article  CAS  PubMed  Google Scholar 

Download references

Author Contributions

Both AK and MJM are equal contribution authors. AK conceptualized the study, prepared the search strategy, reviewed the abstracts and manuscripts for study selection, abstracted the data, performed the data analysis, and prepared the final manuscript. MJM supervised the search strategy, reviewed the abstracts and manuscripts for study selection, abstracted the data, assisted in data analysis, and edited the final manuscript. RD abstracted data for responder analysis, performed the risk of bias assessment, and contributed to manuscript revision. KS performed the data analysis and final manuscript review.

Author information

Author notes

  1. Abhishek Kumar

    Present address: Mercy Medical Center, Cedar Rapids, IA, USA

Authors and Affiliations

  1. State University of New York/University at Buffalo, Buffalo, NY, USA

    Abhishek Kumar, Rajany Dy & M. Jeffery Mador

  2. University of Massachusetts, Worcester, MA, USA

    Kanwaljit Singh

  3. Western New York Veterans Administration Healthcare System, Buffalo, NY, USA

    M. Jeffery Mador

Authors
  1. Abhishek Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajany Dy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kanwaljit Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Jeffery Mador
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhishek Kumar.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest or financial disclosures.

Ethical Approval

This research involves data extracted from already published literature and hence, no human or animal subjects were directly involved.

Informed consent

No informed consent was deemed necessary.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 90 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, A., Dy, R., Singh, K. et al. Early Trends in Bronchoscopic Lung Volume Reduction: A Systematic Review and Meta-analysis of Efficacy Parameters. Lung 195, 19–28 (2017). https://doi.org/10.1007/s00408-016-9969-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9969-x

Keywords

Search

Navigation