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. 2020 Apr 23:15:871-881.
doi: 10.2147/COPD.S240848. eCollection 2020.

Patient Selection for Bronchoscopic Lung Volume Reduction

Jorrit B A Welling  1   2 , Jorine E Hartman  1   2 , Sonja W S Augustijn  1 , Huib A M Kerstjens  1   2 , Lowie E G W Vanfleteren  3 , Karin Klooster  1   2 , Dirk-Jan Slebos  1   2
Affiliations

Patient Selection for Bronchoscopic Lung Volume Reduction

Jorrit B A Welling et al. Int J Chron Obstruct Pulmon Dis. .

Erratum in

Abstract

Purpose: Bronchoscopic lung volume reduction (BLVR) is a valuable treatment option for carefully selected patients with severe COPD. There is limited knowledge about the characteristics and outcomes of patients referred to a specialized center for BLVR. The study objectives were to investigate the selection rate for BLVR treatment in patients referred for this treatment and to investigate the differences between patients that were selected for BLVR and patients that were not.

Patients and methods: We performed a retrospective analysis of patients with severe COPD who were referred to our hospital to assess eligibility for BLVR treatment. Our parameters included demographics, comorbidity, chest computed tomography characteristics, reasons for rejection from BLVR treatment and patient survival.

Results: In total, 1500 patients were included (mean age 62 years, 50% female and forced expiratory volume in 1 s 33% of predicted). Out of this group, 282 (19%) patients were selected for BLVR treatment. The absence of a suitable target lobe for treatment, an unsuitable disease phenotype and insufficient lung hyperinflation were the most important factors for not being selected. Patients that were selected for any BLVR option lived significantly longer than the group of patients that were not selected for BLVR (median 3060 versus 2079 days, P<0.001).

Conclusion: We found that only a small proportion of patients that are referred for BLVR treatment is eligible for a BLVR treatment, indicating a need for both better referral tools and for the development of new therapies for this group of patients. Furthermore, our data suggest that selection for BLVR is associated with a significant survival benefit.

Keywords: bronchoscopic lung volume reduction; endobronchial valves; lung volume reduction coils; patient selection.

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Conflict of interest statement

LEGWV reports grants and personal fees from AstraZeneca, personal fees from Novartis, personal fees from GSK, personal fees from Chiesi, personal fees from Menarini, personal fees from Pulmonx, grants from Fisher & Paykel, grants from Philips, personal fees from Boehringer, all outside the submitted work. HAMK reports grants from GSK, grants from Novartis, grants from Boehringer Ingelheim, outside the submitted work. DJS reports grants, personal fees, and non-financial support from PulmonX Inc., CA, USA, grants, personal fees, and non-financial support from PneumRx/BTG, CA, USA, grants and non-financial support from Nuvaira, MN, USA, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Qualitative scale of emphysematous destruction, scored on a 0 to 4 scale with higher scores indicating more emphysematous destruction.
Figure 2
Figure 2
Study flowchart. Abbreviation: PLVR, polymeric lung volume reduction.
Figure 3
Figure 3
Kaplan-Meier plots of survival. (A) Survival of the patients that were selected for treatment and the patients that were not selected for treatment. (B) Survival of the patients that were selected for EBV, selected for LVRC, invited to our hospital for consultation but not selected for BLVR, not selected for BLVR and not invited to our hospital for consultation. Abbreviations: EBV, endobronchial valve treatment; LVRC, lung volume reduction coil treatment; BLVR, bronchoscopic lung volume reduction; MDT, multidisciplinary team meeting.
Figure 4
Figure 4
Eligibility for EBV and LVRC after application of current inclusion and exclusion criteria. (A) Eligible patients for EBV treatment. (B) Eligible patients for LVRC treatment. Abbreviations: N, number of patients; FEV1, forced expiratory volume in 1 s; RV, residual volume; TLC, total lung capacity; EBV, endobronchial valve treatment; LUL, left upper lobe; RUL, right upper lobe; LLL, left lower lobe; RLL, right lower lobe; LVRC, lung volume reduction coil treatment.
See this image and copyright information in PMC

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