Lung volume reduction with endobronchial coils for patients with emphysema

Abstract

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.

Keywords: Lung volume reduction; bronchoscopy; chronic obstructive pulmonary disease (COPD); coils; emphysema.

Figure 1

RePneu Coil (125 mm); used with permission of PneumRx/BTG.

Figure 2

Coil treatment radiological imaging. (A) Fluoroscopic image during coil treatment of the right upper lobe in a severe emphysema patient; (B) chest X-ray after treatment with coils.

Figure 3

Coil Associated Opacity. (A) Post-treatment chest X-ray displaying a mild consolidation around the coil position (“Coil Associated Opacity”) in the right lung; (B) chest X-ray 12 months post-treatment in the same patient showing significant volume reduction in both upper lobes due to a post inflammatory fibrotic crowding reaction of the coils resulting in a beneficiary outcome.