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Endoskopische Behandlungsmöglichkeiten bei obstruktiven Atemwegserkrankungen

Endoscopic treatment options in patients with obstructive airway diseases

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Bei Asthmatikern versucht man mit der bronchoskopischen Thermoplastie, die Masse oder Kontraktionsfähigkeit von glatten Muskelzellen zu reduzieren. Hier gibt es erste klinische Erfolge wenngleich noch keine Langzeitergebnisse vorliegen. Bei der Behandlung des Lungenemphysems konkurrieren mehrere Verfahren und Firmen. Einerseits versucht man durch Einlage von Bypassstents zwischen den zentralen Atemwegen und einer bullösen Formation eine Entblähung zu erreichen. Die anderen Verfahren zielen darauf ab, emphysematös besonders befallene Areale von der Ventilation auszuschließen und ggf. zum Kollaps zu bringen. Durch die dort induzierte Atelektase sollen die weniger befallenen Lungenanteile für die Ventilation rekrutiert und die Atemmuskelfunktion verbessert werden. Verschiedenste Stopfen, Einwegventile, Klebstoffe und thermisch irritative Verfahren werden in Studien erprobt. Die kollaterale Ventilation steht der gewünschten Atelektasebildung oft entgegen. Die möglichen Risiken wie Pneumothoraces oder poststenotische Pneumonien müssen gegenüber dem klinischen Gewinn der endoskopischen Lungenvolumenreduktion abgewogen werden. Es zeichnet sich ab, dass sorgfältig selektionierte Patienten durchaus profitieren, dass aber sicher nicht bei jedem Emphysematiker durch interventionelle Bronchoskopie Beschwerdefreiheit erzielt werden kann. Neue prädiktive Messmethoden müssen entwickelt werden, um Therapieempfehlungen geben zu können.

Abstract

Endobronchial thermoplasty is a new treatment approach for asthmatic patients aiming to reduce the volume and contractility of airway smooth muscle cells. Early results are promising, but long-term effects are still unknown. In the endoscopic treatment of emphysema patients, several techniques and companies are competing. One approach aims at deflating emphysematous zones of the lung by placing transbronchial bypass stents from the hyperinflated segments towards the central airways. Other techniques occlude the airways that supply the emphysematous lobes. Shutting off the most diseased parts is designed to reduce their volume. As the lung shrinks, less damaged parenchyma can be recruited and ventilatory muscle function may improve. Various plugs, valves, bio-glues and thermally irritant techniques are currently being tested. Collateral ventilation may prevent the intended atelectasis development. Potential risks such as pneumothoraces and post-obstructive pneumonia must be weighed up against possible clinical benefits. Results of studies indicate that carefully selected emphysema patients can benefit from these new technologies. New predictive methods must be developed to facilitate treatment decisions.

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  1. Zentrum für Pneumologie und Thoraxchirurgie, Abt. Pneumologie, Ruhrlandklinik, Universität Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Deutschland

    L. Freitag

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Freitag, L. Endoskopische Behandlungsmöglichkeiten bei obstruktiven Atemwegserkrankungen. Pneumologe 6, 96–105 (2009). https://doi.org/10.1007/s10405-008-0265-1

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