Advanced bronchoscopy therapies for emphysema: current state and future potentials

Emphysema is a phenotype of chronic obstructive pulmonary disease that is characterized by irreversible parenchyma destruction and loss of elastic recoil, resulting in air trapping and hyperinflation. Despite optimal medical management, many patients remain symptomatic. Bronchoscopic lung volume reduction (BLVR) techniques provide minimally invasive alternatives to surgery. This review summarizes the current role and future directions of advanced bronchoscopic therapies for emphysema.

Established BLVR approaches aim to induce atelectasis of diseased, hyperinflated lobes using endobronchial valves or thermal vapor ablation. Patient selection and clinical efficacy is critically influenced by emphysema distribution and the presence of collateral ventilation. To address these limitations, novel therapies are being developed. Sealants are under investigation as adjuncts to valve therapy to overcome collateral ventilation. Endobronchial coils mechanically re-tension the lung parenchyma, improving elastic recoil and airway patency. Airway stents and scaffolds are designed to facilitate expiratory flow by either bypassing or preventing closure of collapsible airways. These emerging modalities may extend treatment options to patients with homogeneous disease and those with significant collateral ventilation, groups traditionally with limited existing interventions.

Current BLVR therapies remain limited in homogeneous disease and collateral ventilation-positive patients. Research into novel treatments have shown promise in an expanding therapeutic landscape, though long-term safety, durability, and patient selection criteria require further study.