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Lung volume reduction therapies for advanced emphysema: an update
Robert L Berger1, Malcolm M Decamp, Gerard J Criner
1Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Deaconess, Boston, MA 02215, USA. robert_berger@hms.harvard.edu
Chest
|August 5, 2010
Summary
Lung volume reduction surgery (LVRS) offers significant benefits for emphysema patients but is underutilized. Bronchoscopic emphysema treatments (BET) show promise for improved quality of life but lack proven physiologic benefits.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Interventional Pulmonology
Background:
- Lung volume reduction surgery (LVRS) is proven to improve outcomes in select emphysema patients.
- Underutilization of LVRS is partly due to negative reporting on its risks and benefits.
- Bronchoscopic emphysema treatments (BET) aim to reduce risks and costs associated with LVRS.
Purpose of the Study:
- To evaluate the efficacy and safety of various bronchoscopic lung volume reduction strategies.
- To compare bronchoscopic methods with traditional LVRS for emphysema treatment.
- To assess the impact of BET on symptoms, lung function, exercise tolerance, and survival.
Main Methods:
- Review of observational and randomized studies on LVRS.
- Analysis of pilot and pivotal clinical trials for three BET methods: unidirectional valves, biologic lung volume reduction (BioLVR), and airway bypass tract (ABT).
- Assessment of outcomes including mortality, morbidity, symptoms, lung function, and quality of life.
Main Results:
- Bronchoscopic strategies are associated with lower mortality and morbidity compared to LVRS.
- Most BET approaches demonstrate improvements in quality of life.
- Physiologic or exercise tolerance benefits were not consistently observed with bronchoscopic methods.
- BET methods appear less efficient than LVRS in improving lung function and exercise capacity.
Conclusions:
- While bronchoscopic lung volume reduction strategies show potential for improved quality of life with lower risks, they are less efficient than LVRS.
- Current evidence is insufficient to recommend widespread use of BET for emphysema treatment.
- Further research is needed to establish the long-term efficacy and role of BET in emphysema management.
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