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. 2021;100(5):443-451.
doi: 10.1159/000514319. Epub 2021 Mar 19.

Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema

Jorine E Hartman  1 , Karin Klooster  2 , Sonja W S Augustijn  2 , Wouter H van Geffen  3 , Justin L Garner  4   5   6 , Pallav L Shah  4   5   6 , Nick H T Ten Hacken  2 , Dirk-Jan Slebos  2
Affiliations

Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema

Jorine E Hartman et al. Respiration. 2021.

Abstract

Background: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown.

Objectives: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment.

Methods: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment.

Results: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level.

Conclusions: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.

Keywords: Bronchoscopic lung volume reduction; COPD; Emphysema.

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Conflict of interest statement

J.E.H., K.K., N.H.T.t.H., S.W.S.A., W.v.G., and J.L.G. have no conflicts of interest to declare. P.S. reports personal fees from Boston Scientific, CSA Medical, Creo Medical, Nuvairia Olympus, Medtronic, and PneumRX/BTG as consultant on scientific advisory board, sponsorship to Imperial College for a bronchoscopy course by from ERBE, Cook medical, Medtronic, Boston Scientific, Broncus, Pulmonx, Olympus, and PneumRX/BTG, all outside the submitted work. He has been an investigator on clinical trials with bronchial thermoplasty, endobronchial valves, endobronchial coils, thermal ablation, and the airway bypass procedure. DJS reports grants, nonfinancial support, and other from Nuvaira Inc., Minneapolis, MN, USA; grants and nonfinancial support from CSA medical, Boston, MA, USA; grants, personal fees, and nonfinancial support from PulmonX Inc., Redwood City, CA, USA; and grants and nonfinancial support from PneumRx/BTG, California, USA, all outside the submitted work.

Figures

Fig. 1
Fig. 1
Study flowchart. RV, residual volume; 6MWD, 6-min walk distance; TLC, total lung capacity.
Fig. 2
Fig. 2
Schematic overview of the potential mechanism of action of the coil treatment. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; TLC, total lung capacity difference; VA, alveolar volume; IC, inspiratory capacity; MPT, metronome paced test; 6MWD, 6-min walk distance; TLC, total lung capacity; MEP, maximal expiratory pressure; CAO, coil-associated opacity.
See this image and copyright information in PMC

Comment in

References

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