Bronchoscopic interventions in the management of chronic obstructive pulmonary disease

In the past few years, there have been exciting developments in bronchoscopic efforts at attaining lung volume reduction (LVR), given real and perceived risks of surgical LVR. The purpose of this review is to discuss these techniques, with special emphasis on what we have learnt in the past 1-2 years.

Bronchoscopic techniques can be broadly classified as one-way valves, which allow air to exit but not enter, thus reducing air trapping; airway bypass stents, which create an extra-anatomical pathway for air to exit; biologic and polymeric substances, which seal the emphysematous lung, eventually collapsing it; bronchial thermal vapor ablation, which causes thermal damage and thus achieves LVR; and endobronchial elastic coils, which mechanically cause LVR. The specific role of these is being defined by recent publications. The central role of collateral ventilation in choosing amongst these procedures is now established, as it has become clear that in the presence of collateral ventilation, valves provide only modest benefit, if any at all. Thus it is of interest that the other modalities which are independent of collateral ventilation are being studied further.

Though the preliminary results are quite encouraging, further trials need to be done before these procedures can be adopted in daily practice.