Impact of comorbidities on endobronchial valve treatment response in severe emphysema patients

Endobronchial valve (EBV) therapy is an established intervention for patients with advanced emphysema with lung hyperinflation, improving pulmonary function, exercise capacity, and quality of life. Although comorbidities are highly prevalent in this patient population, their effect on EBV treatment outcomes remains unclear. This study aimed to investigate the impact of comorbidities on clinical EBV treatment response in routine clinical practice.

Baseline and 12-month follow-up data were extracted from a prospective registry of EBV procedures conducted between 2016 and 2023. Comorbidities were self-reported via a questionnaire and validated with medical records. Patients were stratified by comorbidity burden: <3 and ≥ 3 comorbidities. Between-group comparisons included relative changes in forced expiratory volume in 1 s (FEV₁), residual volume (RV), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), safety outcomes, and patient-reported satisfaction.

In total, 202 patients were included of whom 103 (51%) had ≥3 (range 3-7) comorbidities. Both comorbidity groups demonstrated significant improvements in FEV₁, RV, 6MWD, and SGRQ at 12 months following EBV treatment, with no significant differences between groups. Notably, patients with a higher comorbidity burden did not show a higher rate of adverse events. Additionally, both groups reported similarly high levels of satisfaction with treatment outcomes, with more than three quarter of patients expressing satisfaction.

Our results show that EBV treatment provided similar favourable clinical improvements with comparable safety profiles, regardless of patients their comorbidity burden. These findings underscore the importance of considering patients with comorbidities for EBV evaluation and referral.