[Bronchoscopic lung volume reduction in patients with severe homogeneous lung emphysema: a pilot study]

After bronchoscopic lung-volume reduction (LVR) improvement in pulmonary function and exercising tolerance can be achieved in patients with severe heterogeneous lung emphysema. Feasibility and safety for one-way valve placement in homogeneous emphysema were evaluated.

Ten patients entered this prospective study. In all cases a homogeneous distribution was confirmed by computer analysis of the CT-scans. We performed unilateral LVR and occluded the lobe with the lowest perfusion, measured by nuclear scintigraphy. Endpoints of the study were changes in lung function test, quality of life and 6-minutes-walk-test (6-MWT) at day 30 and 90 and the safety of the procedure.

Preoperative mean forced expiratory volume in 1 second (FEV1) was 0.93 l (range 0.55 - 1.35 l), mean residual volume was 5.23 l (3.55 - 8.24 l) and 6-MWT was 325 m ( 150 - 480 m). Improvement of dyspnoe and exercising tolerance was reported in 7 cases. No major changes in lung function were evident at days 30 and 90. A trend towards improvement was observed in 6-MWT (DeltaMW + 10.4 +/- 9.8 %). One pneumothorax was noticed, in one case the valves were removed after 90 days because of recurrent infections.

This study shows that bronchoscopic LVR in patients with severe homogeneous emphysema is feasible and seems to be safe. In contrast to surgical LVR patients may have a cinical benefit by bronchoscopic treatment. Longtime follow -up and patient selection criteria have to be examined in larger trials.