RESUMEN
Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert guidelines as one of the few additive treatments to benefit patients with advanced chronic obstructive pulmonary disease (COPD) who are otherwise receiving optimal medical and supportive care. Despite these recommendations and a growing evidence base, these procedures are not widely offered across Australia and New Zealand, and general practitioner and physician awareness of this therapy can be improved. ELVR aims to mitigate the impact of hyperinflation and gas trapping on dyspnoea and exercise intolerance in COPD. Effective ELVR is of proven benefit in improving symptoms, quality of life, lung function and survival. Several endoscopic techniques to achieve ELVR have been developed, with endobronchial valve placement to collapse a single lobe being the most widely studied and commonly practised. This review describes the physiological rationale underpinning lung volume reduction, highlights the challenges of patient selection, and provides an overview of the evidence for current and investigational endoscopic interventions for COPD.
Asunto(s)
Broncoscopía/métodos , Disnea/fisiopatología , Neumonectomía/instrumentación , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Australia/epidemiología , Concienciación , Broncoscopía/normas , Humanos , Nueva Zelanda/epidemiología , Selección de Paciente/ética , Neumonectomía/métodos , Neumonectomía/mortalidad , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Residual/fisiología , Instrumentos Quirúrgicos/efectos adversos , Sobrevida , Capacidad Pulmonar Total/fisiologíaRESUMEN
The past four decades have yielded advances in molecular biology allowing detailed characterization of the cellular genome and the transcriptome: the complete set of RNA species transcribed by a cell or tissue. Through transcriptomics and next-generation sequencing, we can now attain an unprecedented level of detail in understanding cellular phenotypes through examining the genes expressed in specific physiological and pathological states. In this review, we provide an overview of transcriptomics and RNA-sequencing in the analysis of whole tissue and single cells. We describe the techniques and pitfalls involved in the isolation and sequencing of single cells, and what additional benefits this application can provide. Finally, we look to how these technologies are being applied in pulmonary research, and how they may translate in the near future into clinical practice.
