Endobronchial lung volume reduction with valves reduces exacerbations in severe emphysema patients.

BACKGROUND AND OBJECTIVE: Exacerbations drive the progression of chronic obstructive pulmonary disease (COPD). Endoscopic lung volume reduction (ELVR) with valves is an established treatment option for patients with severe emphysema. Post-interventional exacerbations are observed in 8-17% of cases. Whether the exacerbation rate changes in the medium term after ELVR, is not known. METHODS: This is a single-center retrospective analysis of severe emphysema patients with endobronchial valve implantation. The number of exacerbations before and after ELVR was compared, including lung function parameters, exercise capacity and degree of lung volume reduction. The primary endpoint of the study was the number of exacerbations one year after ELVR compared to one year before ELVR. RESULTS: 129 patients (mean age 64.1 ± 7.7 years, 57% female, mean FEV1 0.8 ± 0.2 l, mean RV 243.4 ± 54.9 %) with ELVR in the years 2016-2019 and complete exacerbation history were analyzed. Patients experienced a mean of 2.5 ± 2.2 moderate and severe exacerbations in the year before ELVR. The number of exacerbations decreased significantly to 1.8 ± 2.2 exacerbations in the first year after ELVR (p = 0.009). The decrease in exacerbation rate was associated with the development of complete lobar atelectasis (r = 0.228. p = 0.009). Accordingly, in 41 patients with complete lobar atelectasis, the decrease in exacerbation rate was higher from 2.8 ± 2.0 to 1.4 ± 1.8 exacerbations (p < 0.001). CONCLUSIONS: ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved.

Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung Volume Reduction.

Purpose: Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit. Patients and Methods: We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified. Results: We identified 73 patients with 1-12 revision bronchoscopies and 1-5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before. Conclusion: Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.