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Endoscopic volume reduction in COPD- a critical review
Daniela Gompelmann1, Ralf Eberhardt, Felix Herth
1Pneumology and Respiratory Critical Care Medicine, Thorax Clinic at Heidelberg University Hospital, Translational Research Center Heidelberg.
Deutsches Arzteblatt International
|January 6, 2015
Summary
Endoscopic lung volume reduction offers new options for advanced emphysema patients. Techniques like valve implantation and coil insertion show promise in improving lung function and quality of life.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Thoracic Surgery
Background:
- Chronic obstructive pulmonary disease (COPD) affects 13.2% of Germany's population.
- Current COPD treatments are primarily symptomatic, with limited benefit from lung transplantation.
- Endoscopic lung volume reduction (ELVR) has emerged as a therapeutic option for advanced pulmonary emphysema.
Purpose of the Study:
- To review the current landscape of endoscopic lung volume reduction (ELVR) techniques.
- To assess the efficacy and safety of different ELVR methods for advanced pulmonary emphysema.
Main Methods:
- Literature review of publications from PubMed using keywords: "endoscopic lung volume reduction," "endobronchial valves," "endobronchial coil," and "bronchoscopic thermal vapor ablation."
- Inclusion of data from the German Respiratory Society annual meeting.
Main Results:
- Endoscopic valve implantation, effective in patients with minimal collateral ventilation, showed lobar volume reduction (56-80%) and improved FEV1 (16-26%), with pneumothorax as a key complication (up to 23%).
- Coil implantation demonstrated significant quality of life improvements (SGRQ: -8 points) in one RCT.
- Bronchoscopic thermoablation reduced lobar volume by 48% in upper lobe-predominant emphysema patients.
Conclusions:
- Endoscopic lung volume reduction expands therapeutic options for select advanced pulmonary emphysema patients.
- Further prospective trials are necessary to fully evaluate the long-term benefits and risks of current ELVR techniques.
