Lung volume reduction in emphysema: a pragmatic prospective cohort study

Area of Science:

• Pulmonology
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Limited guidance exists for implementing lung volume reduction interventions in clinical practice.
• Heterogeneous emphysema management requires effective strategies.

Purpose of the Study:

• To evaluate endoscopic lung volume reduction (ELVR) versus no-ELVR, followed by lung volume reduction surgery (LVRS) in patients with severe heterogeneous emphysema.
• To assess the efficacy and safety of ELVR and LVRS in improving lung function and quality of life.

Main Methods:

• A pragmatic prospective monocentre cohort study.
• Comparison of ELVR (n=20) versus no-ELVR (n=18) for 6-month follow-up.
• Subsequent evaluation of LVRS (n=16) in eligible patients with 6-month follow-up.

Main Results:

• At 3 months, 70% of ELVR, 11% of no-ELVR, and 69% of LVRS patients showed a forced expiratory volume in 1 second (FEV1) improvement of ≥100 mL.
• At 6 months, ELVR showed significant improvements in FEV1 (+0.21 L), residual volume (RV) (-0.95 L), 6-minute walk distance (6MWD) (+58 m), and St George's Respiratory Questionnaire (SGRQ) (-18 points) compared to no-ELVR.
• LVRS demonstrated greater improvements in FEV1 (+0.27 L) and RV (-1.49 L) but was associated with higher serious adverse events (81% vs 45%) and longer hospital stays (15 vs 5 days).

Conclusions:

• ELVR is an effective and less invasive initial treatment option for severe heterogeneous emphysema.
• LVRS is a powerful alternative, offering greater lung function improvement but with increased risks and resource utilization.
• This study supports a staged approach, prioritizing ELVR before considering LVRS in managing severe heterogeneous emphysema.