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. 2022;101(5):476-484.
doi: 10.1159/000520885. Epub 2021 Dec 22.

Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

Rein Posthuma  1   2   3 , Anouk W Vaes  1 , Kim H M Walraven  2   3 , Peyman Sardari Nia  4 , Jan U Schreiber  5 , Hester A Gietema  6   7 , Geertjan Wesseling  3 , Emiel F M Wouters  1   8 , Lowie E G W Vanfleteren  9   10
Affiliations

Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

Rein Posthuma et al. Respiration. 2022.

Abstract

Background: Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program.

Objectives: In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes.

Method: A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention.

Results: Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT -4 ± 6 points, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ.

Conclusion: Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.

Keywords: Bronchoscopic lung volume reduction; Emphysema; Intervention; Interventional bronchoscopy.

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Conflict of interest statement

R.P. has received honoraria for lectures from Health investment, Medtalks, and Chronisch Zorgnet, A.W.V. has no conflicts of interest, K.H.M.W. has no conflicts of interest, P.S.N. has no conflicts of interest, J.U.S. has no conflicts of interest, H.A.G. has no conflicts of interest, G.W. has no conflicts of interest, E.F.M.W. has no conflicts of interest, L.E.G.W.V. reports consulting fees from GSK and AstraZeneca, honoraria for lectures from GSK, AstraZeneca, Resmed, and Boehringer, and the Data Safety Monitoring Board, AstraZeneca.

Figures

Fig. 1
Fig. 1
Flowchart of screened COPD subjects and reason for exclusion. Data are shown as n. Counts reflect the number of subjects with the specific reason for ineligibility. Subjects could have multiple reasons for being unsuitable for BLVR. COPD, chronic obstructive pulmonary disease; BLVR, bronchoscopic lung volume reduction; EBV, endobronchial valve; mMRC, Modified Medical Research Council Dyspnoea Scale; 6MWT, 6-Minute Walking Test; m, metre; FEV1, forced expiratory volume in 1 s.
Fig. 2
Fig. 2
Outcomes at 3 months. Shown are the changes in outcome at 3 months in subjects treated with EBV. Black horizontal lines represent the MCID of 2 points in CAT score, 100 mL change in FEV1, 25 m on 6MWT, and a reduction of 430 mL in RV. EBV, endobronchial valve; MCID, minimal clinically important difference; FEV1, forced expiratory volume in 1 s; 6MWD, 6-min walk distance; RV, residual volume; CAT, COPD assessment test.
See this image and copyright information in PMC

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