Bronchoscopic interventions for emphysema: Current status.

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Medical Devices

Background:

• Chronic obstructive pulmonary disease (COPD) is a major global health concern.
• Severe emphysema significantly impacts patient quality of life and prognosis.
• Bronchoscopic lung volume reduction (BLVR) techniques represent advanced therapeutic options for select COPD patients.

Purpose of the Study:

• To review current bronchoscopic lung volume reduction (BLVR) techniques for severe emphysema.
• To discuss the mechanisms, reversibility, and influencing factors of different BLVR methods.
• To highlight the importance of assessing interlobar collateral ventilation (CV) for treatment success.

Main Methods:

• Review of existing literature on various BLVR techniques including endobronchial/intrabronchial valves (EBV/IBV), lung volume reduction coils (LVRCs), and bronchoscopic thermal vapor ablation (BTVA).
• Discussion of the principles behind each technique: lobar atelectasis for EBV/IBV, mechanical compression for LVRCs, and inflammatory processes for BTVA.
• Emphasis on the role of radiological and endoscopic assessments for collateral ventilation (CV).

Main Results:

• BLVR techniques demonstrate acceptable safety and short-term clinical efficacy in subgroups of patients with severe emphysema.
• EBV/IBV achieve lung volume reduction via lobar atelectasis, with reversible effects.
• LVRCs and BTVA induce tissue compression; LVRC effects are partially reversible, BTVA effects are irreversible. Interlobar CV significantly impacts EBV/IBV outcomes.

Conclusions:

• BLVR techniques offer personalized therapeutic options for severe emphysema.
• Accurate assessment of collateral ventilation is vital for optimizing outcomes, particularly for valve-based procedures.
• Further research, including head-to-head trials, is necessary to establish long-term benefits, durability, and cost-effectiveness.