Endoscopic lung volume reduction coil treatment in patients with very low FEV1: an observational study

Abstract

Background: Endoscopic lung volume reduction coil (LVRC) treatment is a therapeutic option for selected patients with advanced emphysema. The effects and the safety of endoscopic lung volume reduction in patients with very low forced expired volume in one second (FEV₁) remain to be determined. This study was conducted to assess the effects and the safety of LVRC treatment in patients with very low FEV₁.

Methods: The study was performed as a retrospective observational study in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf on patients with very low FEV₁, defined as an FEV₁ ⩽ 20% of predicted at baseline in whom LVRC treatment was performed between 1 April 2012 and 28 February 2017.

Results: LVRC treatment was performed in 33 patients with very low FEV₁. Of these, 45.5% were female and 54.5% were male. At baseline, mean FEV₁ was 0.46 ± 0.12 liters (15 ± 3% of predicted), mean forced vital capacity (FVC) was 1.61 ± 0.62 liters (42 ± 13% of predicted), mean residual volume (RV) was 6.03 ± 0.81 liters (275 ± 51% of predicted) and 6-minute walk distance was 229 ± 102 m. Bilateral LVRC treatment was completed in 21 of these patients (63.6%). Bilateral LVRC treatment led to significant improvements in functional parameters with an increase in mean FEV₁ from 0.44 ± 0.11 liters to 0.54 ± 0.12 liters ( p = 0.001), equivalent to a relative improvement of 24.5 ± 26.9%, an increase in mean FVC from 1.49 ± 0.54 liters to 1.84 ± 0.49 liters ( p = 0.001), a decrease in mean RV from 6.27 ± 0.83 liters to 5.83 ± 1.09 liters ( p = 0.004) and an improvement in 6-minute walk distance from 218 ± 91 m to 266 ± 96 m ( p = 0.01). There were no cases of respiratory failure requiring mechanical ventilation and no deaths.

Conclusions: LVRC treatment was effective and safe in patients with very low FEV₁.

Keywords: emphysema; endoscopic lung volume reduction; endoscopic lung volume reduction coil; interventional pulmonology.

Figure 1.

Flow diagram illustrating the process of case selection. COPD, chronic obstructive pulmonary disease; FEV₁, forced expired volume in one second; LVRC, endoscopic lung volume reduction coil.

Figure 2.

Functional parameters at baseline and follow up for patients completing bilateral lung volume reduction coil (LVRC) treatment and for patients with unilateral treatment only. Follow-up values in patients completing bilateral treatment were collected at a median of 84 days after the first procedure and at a median of 49 days after the second procedure. *Values for patients with unilateral LVRC treatment only. Follow-up values in patients treated unilaterally only were collected at a median of 70 days after the procedure. FEV₁, forced expired volume in one second; FVC, forced vital capacity; n.s., not statistically significant; RV, residual volume; 6-MWT, 6-minute walk test.