Position statement on endoscopic lung volume reduction in South Africa: 2022 update

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Respiratory Medicine

Background:

• Chronic obstructive pulmonary disease (COPD) is a major health concern in South Africa.
• Endoscopic lung volume reduction (ELVR) was introduced in South Africa in 2015 for advanced emphysema.
• Growing evidence supports ELVR for select emphysema patients, aligning with international guidelines.

Purpose of the Study:

• To provide South African healthcare professionals and funders with an overview of ELVR.
• To detail the current evidence and practical aspects of using endoscopic valves and other ELVR modalities.
• To guide the judicious application of ELVR in managing advanced emphysema.

Main Methods:

• Review of current evidence supporting ELVR for advanced emphysema.
• Identification of patient selection criteria based on GOLD and NICE guidelines.
• Assessment of diagnostic tools for identifying target lobes, including HRCT and collateral ventilation assessment.
• Consideration of contraindications for ELVR procedures.

Main Results:

• International guidelines (GOLD, NICE) now recommend endoscopic valves for COPD based on Level A evidence.
• Specific patient criteria for ELVR referral include age (40-75), severe dyspnea (CAT score ≥10), FEV1 (20-50%), hyperinflation (RV >175% or RV/TLC >55%), and 6MWD (100-450m).
• High-resolution CT and collateral ventilation assessment are key for target lobe selection.

Conclusions:

• ELVR, particularly with endoscopic valves, is a viable treatment for a well-defined subgroup of advanced emphysema patients.
• Adherence to established criteria and thorough pre-procedural assessment are essential for successful ELVR implementation.
• This statement aims to facilitate informed decision-making regarding ELVR for South African clinicians and funders.