Abstract
Lung volume reduction surgery is a proven palliative procedure for emphysema, and in patients with heterogeneous upper lobe disease, as well as low-baseline exercise capacity, even mortality benefits can be realized. However, its application is limited by high postoperative morbidity and stringent selection criteria that effectively exclude many patients. This has been the impetus for the development of less invasive approaches to lung volume reduction. A range of different bronchoscopic techniques such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been investigated. The underlying physiological mechanisms of the various endoscopic modalities differ, and both homogeneous as well as heterogeneous emphysema have been targeted. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive although subjective benefit in dyspnoea scores and quality of life is a frequent finding. Improvements in objective outcomes such as spirometry or exercise tolerance have been only modest. Refining patient selection and dose of treatment are subjects of ongoing research to improve the efficacy data. Safety profiles are more promising with rare procedure-related mortality and fewer complications than surgical lung volume reduction. The field of bronchoscopic lung volume reduction continues to evolve with the aim of making symptom palliation more available to a wider range of patients at lower risks.
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Abbreviations
- COPD:
-
Chronic obstructive pulmonary disease
- NETT:
-
National Emphysema Treatment Trial
- SGRQ:
-
St George’s Respiratory Questionnaire
- VENT:
-
Endobronchial Valve for Emphysema Palliation Trial
- CT:
-
Computed tomography
- FEV1 :
-
Forced expiratory volume in 1 s
Suggested Reading
Sciurba FC, Ernst A, Herth FJ, VENT Study Research Group, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010;363(13):1233–44.
Snell GI, Holsworth L, Borrill ZL, et al. The potential for bronchoscopic lung volume reduction using bronchial prostheses: a pilot study. Chest. 2003;124(3):1073–80.
de Oliveira HG, Macedo-Neto AV, John AB, et al. Transbronchoscopic pulmonary emphysema treatment: 1-month to 24-month endoscopic follow-up. Chest. 2006;130(1):190–9.
Berger RL, DeCamp MM, Criner GJ, et al. Lung volume reduction therapies for advanced emphysema: an update. Chest. 2010;138(2):407–17.
D’Andrilli A, Vismara L, Rolla M, et al. Computed tomography with volume rendering for the evaluation of parenchymal hyperinflation after bronchoscopic lung volume reduction. Eur J Cardiothorac Surg. 2009;35(3):403–7.
Aljuri N, Freitag L. Validation and pilot clinical study of a new bronchoscopic method to measure collateral ventilation before endobronchial lung volume reduction. J Appl Physiol. 2009;106(3):774–83.
Hopkinson NS. Bronchoscopic lung volume reduction: indications, effects and prospects. Curr Opin Pulm Med. 2007;13(2):125–30.
Ingenito EP, Wood DE, Utz JP. Bronchoscopic lung volume reduction in severe emphysema. Proc Am Thorac Soc. 2008;5(4):454–60.
Hopkinson NS, Toma TP, Hansell DM, et al. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med. 2005;171(5):453–60.
Snell GI, Hopkins P, Westall G, et al. A feasibility and safety study of bronchoscopic thermal vapor ablation: a novel emphysema therapy. Ann Thorac Surg. 2009;88(6):1993–8.
Emery MJ, Eveland RL, Eveland K, et al. Lung volume reduction by bronchoscopic administration of steam. Am J Respir Crit Care Med. 2010;182:1282–91 [Epub ahead of print].
Reilly J, Washko G, Pinto-Plata V, et al. Biological lung volume reduction: a new bronchoscopic therapy for advanced emphysema. Chest. 2007;131(4):1108–13.
Criner GJ, Pinto-Plata V, Strange C, et al. Biologic lung volume reduction in advanced upper lobe emphysema: phase 2 results. Am J Respir Crit Care Med. 2009;179(9):791–8.
Herth FJ, Eberhard R, Gompelmann D, et al. Bronchoscopic lung volume reduction with a dedicated coil: a clinical pilot study. Ther Adv Respir Dis. 2010;4(4):225–31.
Colt HG, Matsuo T. Hospital charges attributable to bronchoscopy-related complications in outpatients. Respiration. 2001;68:67–72.
Cooper JD. “all that glitters…”: evaluating interventions for emphysema. Chest. 2010;138(2):243–5.
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Ernst, A. (2013). Bronchoscopic Lung Volume Reduction. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_49
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DOI: https://doi.org/10.1007/978-1-4614-4292-9_49
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