Endobronchial Zephyr valves for bronchoscopic lung volume reduction for severe emphysema: a systematic review and...

Chronic obstructive pulmonary disease (COPD) causes permanent lung damage and is a global health issue. Bronchoscopic Lung Volume Reduction (BLVR) with Zephyr valves has increased COPD treatment choices for individuals with persistent symptoms despite maximal drug therapy.

This systematic review and meta-analysis evaluated available Zephyr valve data in severe emphysema patients.

We searched Cochrane, PubMed, Google Scholar, Lilacs, and Science Direct extensively and included eight randomized control trials (RCTs).

This meta-analysis comprises 1083 patients 669 Zephyr valve-treated and 414 control. The mean difference in 6-minute walking distance was 37.53 meters (95% CI: 22.14-52.90, P < 0.001). Statistically significant improvements were also observed in FEV1 predicted percentage (mean difference: 13.64, 95% CI: 8.51-18.77, P < 0.001) and BODE index change (mean difference: -0.79, 95% CI: -1.33 to 0.26, P < 0.05), mMRC dyspnea scale (mean difference: -0.27, 95% CI: -0.55 to 0.02, P < 0.01) and residual volume (mean difference: -0.14, 95% CI: -0.64 to 0.35, P < 0.01). The quality of life measured by SGRQ also improved significantly (mean difference: -6.69, 95% CI: -9.69, -4.23, P < 0.001). While COPD exacerbation rates (OR:1.41, 95% CI: 0.87-2.30, P > 0.05) and pneumonia rates (OR: 1.72, 95% CI: 0.7-4.23, P > 0.05) were similar between valve and control groups, pneumothorax risk was significantly higher in the treatment arm (OR: 11.06, 95% CI: 4.10-29.80, P < 0.001). However, there was no significant difference in all-cause mortality between the groups (OR: 1.69; 95% CI: 0.53-5.38, P > 0.38).

Zephyr valves may improve lung function, exercise capacity, and quality of life in patients suffering from severe emphysema. However, the increased risk of pneumothorax requires careful patient selection and rigorous post-intervention monitoring.