Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: How to Do It

  • Udit Chaddha
  • Julie Lin
  • D. Kyle HogarthEmail author
Interventional Pulmonology (G Cheng, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Interventional Pulmonology


Purpose of Review

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Over the last decade, many studies have validated the use of endobronchial valves (EBVs) for bronchoscopic lung volume reduction (BLVR) in patients who are persistently symptomatic despite optimal medical therapy. We aimed to review the literature and describe appropriate patient selection and procedural considerations.

Recent Findings

BLVR using EBVs leads to an improvement in FEV1, 6-min walk distance, and health-related quality of life. Two valve systems have recently obtained FDA approval for use for this indication. Appropriate selection of the target lobe and assessment of fissure integrity using quantitative imaging software are essential to obtain best possible outcomes.


EBVs are a viable treatment option, with manageable complications, for patients with COPD who have hyperinflation and refractory symptoms, when there is complete fissure integrity (no collateral ventilation).


Lung volume reduction Endobronchial valves COPD Zephyr Spiration 


Compliance with Ethical Standards

Conflict of Interest

In regard to this paper, Dr. Hogarth received an honorarium from Pulmonx for travel and training in 2018. He taught the placement of Zephyr valves at a PulmonX sponsored program at the ATS meeting in Dallas, 2019. He consulted for Spiration in the past (and received consulting fees, honoraria, but has not for over 3 years). He has consulted for Olympus (owner of Spiration) and received consulting fees for his services. He is also a consultant, on the science advisory board, and options holder for Eolo.

Dr. Chaddha and Dr. Lin have nothing to declare.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.CrossRefGoogle Scholar
  2. 2.
    Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2008. Natl Vital Stat Rep. 2011;59(10):1–126.PubMedGoogle Scholar
  3. 3.
    Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691-706.Google Scholar
  4. 4.
    Kew KM, Dias S, Cates CJ. Long-acting inhaled therapy (beta-agonists, anticholinergics and steroids) for COPD: a network meta-analysis. Cochrane Database Syst Rev. 2014;3:CD010844.Google Scholar
  5. 5.
    Vogelmeier CF, Criner GJ, Martínez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Arch Bronconeumol. 2017;53(3):128–49.CrossRefGoogle Scholar
  6. 6.
    Puhan MA, Gimeno-santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016;12:CD005305.PubMedGoogle Scholar
  7. 7.
    Casanova C, Cote C, De torres JP, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(6):591–7.CrossRefGoogle Scholar
  8. 8.
    • Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348(21):2059–73. Landmark study on lung volume reduction.CrossRefGoogle Scholar
  9. 9.
    Criner GJ, Cordova F, Sternberg AL, Martinez FJ. The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med. 2011;184(8):881–93.CrossRefGoogle Scholar
  10. 10.
    Fishman A, Fessler H, Martinez F, et al. Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med. 2001;345(15):1075–83.CrossRefGoogle Scholar
  11. 11.
    Fernandez-bussy S, Labarca G, Herth FJF. Bronchoscopic lung volume reduction in patients with severe emphysema. Semin Respir Crit Care Med. 2018;39(6):685–92.CrossRefGoogle Scholar
  12. 12.
    Shah PL, Zoumot Z, Singh S, et al. Endobronchial coils for the treatment of severe emphysema with hyperinflation (RESET): a randomised controlled trial. Lancet Respir Med. 2013;1(3):233–40.CrossRefGoogle Scholar
  13. 13.
    Sciurba FC, Criner GJ, Strange C, et al. Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema: the RENEW randomized clinical trial. JAMA. 2016;315(20):2178–89.CrossRefGoogle Scholar
  14. 14.
    Deslée G, Mal H, Dutau H, et al. Lung Volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical trial. JAMA. 2016;315(2):175–84.CrossRefGoogle Scholar
  15. 15.
    Shah PL, Slebos DJ, Cardoso PF, et al. Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial. Lancet. 2011;378(9795):997–1005.CrossRefGoogle Scholar
  16. 16.
    Lieberman S, Shulimzon TR, Davidson T, Marom EM. Long-term imaging of the lungs after sealant bronchoscopic lung volume reduction. J Thorac Imaging. 2016;31(6):391–7.CrossRefGoogle Scholar
  17. 17.
    Shah PL, Gompelmann D, Valipour A, et al. Thermal vapour ablation to reduce segmental volume in patients with severe emphysema: STEP-UP 12 month results. Lancet Respir Med. 2016;4(9):e44–5.CrossRefGoogle Scholar
  18. 18.
    Sciurba FC, Ernst A, Herth FJ, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010;363(13):1233–44.CrossRefGoogle Scholar
  19. 19.
    Herth FJ, Noppen M, Valipour A, et al. Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort. Eur Respir J. 2012;39(6):1334–42.CrossRefGoogle Scholar
  20. 20.
    Wood DE, Nader DA, Springmeyer SC, et al. The IBV Valve trial: a multicenter, randomized, double-blind trial of endobronchial therapy for severe emphysema. J Bronchology Interv Pulmonol. 2014;21(4):288–97.CrossRefGoogle Scholar
  21. 21.
    Klooster K. Ten hacken NH, Hartman JE, Kerstjens HA, Van rikxoort EM, Slebos DJ. Endobronchial valves for emphysema without interlobar collateral ventilation. N Engl J Med. 2015;373(24):2325–3.CrossRefGoogle Scholar
  22. 22.
    Davey C, Zoumot Z, Jordan S, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial. Lancet. 2015;386(9998):1066–73.CrossRefGoogle Scholar
  23. 23.
    Valipour A, Slebos DJ, Herth F, et al. Endobronchial valve therapy in patients with homogeneous emphysema. Results from the IMPACT Study. Am J Respir Crit Care Med. 2016;194(9):1073–82.CrossRefGoogle Scholar
  24. 24.
    Kemp SV, Slebos DJ, Kirk A, 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):1535–43.CrossRefGoogle Scholar
  25. 25.
    •• Criner GJ, Sue R, Wright S, 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):1151–64. Largest studies and best-performed studies with the two FDA-approved valves, with outcomes assessed at 6–12 months.CrossRefGoogle Scholar
  26. 26.
    Li S, Wang G, Wang C, et al. The REACH trial: a randomized controlled trial assessing the safety and effectiveness of the Spiration® valve system in the treatment of severe emphysema. Respiration. 2018;1:–12.Google Scholar
  27. 27.
    •• Criner GJ, Delage A, Voelker KG. The EMPROVE trial - a randomized, controlled multicenter clinical study to evaluate the safety and effectiveness of the Spiration® valve system for single lobe treatment of severe emphysema. Am J Respir Crit Care Med. 2018;197:A7753 (Meeting abstract). Largest studies and best-performed studies with the two FDA-approved valves, with outcomes assessed at 6–12 months.Google Scholar
  28. 28.
    Fiorelli A, Santoriello C, De felice A, et al. Bronchoscopic lung volume reduction with endobronchial valves for heterogeneous emphysema: long-term results. J Vis Surg. 2017;3:170.CrossRefGoogle Scholar
  29. 29.
    Gompelmann D, Benjamin N, Bischoff E, et al. Survival after endoscopic valve therapy in patients with severe emphysema. Respiration. 2019;97(2):145–52.CrossRefGoogle Scholar
  30. 30.
    Gülsen A. Effects of bronchoscopic lung volume reduction coil treatment on arterial blood gases. J Bronchology Interv Pulmonol. 2019.Google Scholar
  31. 31.
    Gompelmann D, Herth FJ, Slebos DJ, et al. Pneumothorax following endobronchial valve therapy and its impact on clinical outcomes in severe emphysema. Respiration. 2014;87(6):485–91.CrossRefGoogle Scholar
  32. 32.
    Herth FJF, Slebos DJ, Criner GJ, Valipour A, Sciurba F, Shah PL. Endoscopic lung volume reduction: an expert panel recommendation - update 2019. Respiration. 2019:1–10.Google Scholar
  33. 33.
    Eberhardt R, Gerovasili V, Kontogianni K, et al. Endoscopic lung volume reduction with endobronchial valves in patients with severe emphysema and established pulmonary hypertension. Respiration. 2015;89(1):41–8.CrossRefGoogle Scholar
  34. 34.
    Labaki WW, Martinez CH, Martinez FJ, et al. The role of chest computed tomography in the evaluation and management of the patient with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;196(11):1372–9.CrossRefGoogle Scholar
  35. 35.
    Mets OM, Smit EJ, Mohamed hoesein FA, et al. Visual versus automated evaluation of chest computed tomography for the presence of chronic obstructive pulmonary disease. PLoS ONE. 2012;7(7):e42227.CrossRefGoogle Scholar
  36. 36.
    Welling JBA, Hartman JE, Van rikxoort EM, et al. Minimal important difference of target lobar volume reduction after endobronchial valve treatment for emphysema. Respirology. 2018;23(3):306–10.CrossRefGoogle Scholar
  37. 37.
    Van geffen WH, Slebos DJ, Herth FJ, Kemp SV, Weder W, Shah PL. Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis. Lancet Respir Med. 2019.Google Scholar
  38. 38.
    Koster TD. Van rikxoort EM, Huebner RH, et al. Predicting lung volume reduction after endobronchial valve therapy is maximized using a combination of diagnostic tools. Respiration. 2016;92(3):150–7.CrossRefGoogle Scholar
  39. 39.
    Herth FJ, Eberhardt R, Gompelmann D, et al. Radiological and clinical outcomes of using Chartis™ to plan endobronchial valve treatment. Eur Respir J. 2013;41(2):302–8.CrossRefGoogle Scholar
  40. 40.
    Welling JBA, Hartman JE, NHT T h, et al. Chartis measurement of collateral ventilation: conscious sedation versus general anesthesia - a retrospective comparison. Respiration. 2018;96(5):480–7.CrossRefGoogle Scholar
  41. 41.
    Gompelmann D, Lim HJ, Eberhardt R, et al. Predictors of pneumothorax following endoscopic valve therapy in patients with severe emphysema. Int J Chron Obstruct Pulmon Dis. 2016;11:1767–73.CrossRefGoogle Scholar
  42. 42.
    Valipour A, Slebos DJ, De oliveira HG, et al. Expert statement: pneumothorax associated with endoscopic valve therapy for emphysema--potential mechanisms, treatment algorithm, and case examples. Respiration. 2014;87(6):513–21.CrossRefGoogle Scholar
  43. 43.
    The Global Strategy for Diagnosis. Management and prevention of COPD, updated 2019. Available from:
  44. 44.
    Excellence NI. Endobronchial valve insertion to reduce lung volume in emphysema., 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Section of Pulmonary and Critical CareUniversity of Chicago MedicineChicagoUSA

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