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Update on Nonsurgical Lung Volume Reduction Procedures.

J Alberto Neder1, Denis E O'Donnell1

  • 1Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada K7L 2V6.

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|July 23, 2016
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Summary
This summary is machine-generated.

Endoscopic lung volume reduction (ELVR) offers new hope for advanced COPD patients. Procedures like valve implants and coil implants aim to reduce lung deflation, improving breathing and reducing shortness of breath.

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Area of Science:

  • Pulmonology
  • Interventional Pulmonology
  • Respiratory Medicine

Background:

  • Advanced Chronic Obstructive Pulmonary Disease (COPD) presents significant challenges in managing respiratory mechanics and chronic dyspnea.
  • Endoscopic Lung Volume Reduction (ELVR) strategies are gaining traction as a less invasive alternative to surgical lung volume reduction (LVRS).

Purpose of the Study:

  • To review current endoscopic lung volume reduction (ELVR) strategies for advanced COPD.
  • To outline patient selection criteria and pre-procedural assessment guidelines for ELVR.
  • To discuss the procedural choices based on patient-specific anatomical and physiological factors.

Main Methods:

  • Review of current literature on ELVR techniques including valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents.
  • Identification of key patient characteristics indicating suitability for ELVR, focusing on severe air trapping and thoracic hyperinflation.
  • Outline of recommended pre-procedural assessments, including imaging and functional testing.

Main Results:

  • Patients with severe air trapping (inspiratory capacity/TLC < 25%) and hyperinflation (TLC > 150%) are most likely to benefit from ELVR.
  • Comprehensive pre-ELVR assessment should include cardiological evaluation, high-resolution CT, V/Q scintigraphy, PFTs, and CPET.
  • One-way valves are preferred for complete lobar exclusion without collateral ventilation; coil implants or BioLVR are alternatives for incomplete fissures or collateral ventilation.

Conclusions:

  • ELVR procedures are available in select Canadian centers within clinical trials.
  • The choice of ELVR technique depends on the presence of complete lobar exclusion, collateral ventilation, and fissure integrity.
  • These endoscopic approaches aim to improve respiratory mechanics and alleviate dyspnea in carefully selected COPD patients.