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Randomized Controlled Trial
. 2022 Dec;27(12):1064-1072.
doi: 10.1111/resp.14338. Epub 2022 Aug 2.

Reversal of collateral ventilation using endoscopic polymer foam in COPD patients undergoing endoscopic lung volume reduction with endobronchial valves: A controlled parallel group trial

Alvin J Ing  1 , Anand Jayapadman  1 , Woo-Veen Kim  1 , Chelsea Ly  1 , Kevin Ho-Shon  1 , Paul Lilburn  2   3   4 , Alan Carew  5 , Benjamin J H Ng  6 , Tajalli Saghaie  1 , Jonathan P Williamson  1
Affiliations
Randomized Controlled Trial

Reversal of collateral ventilation using endoscopic polymer foam in COPD patients undergoing endoscopic lung volume reduction with endobronchial valves: A controlled parallel group trial

Alvin J Ing et al. Respirology. 2022 Dec.

Abstract

Background and objective: We have previously described reversal of collateral ventilation (CV) in a severe chronic obstructive pulmonary disease (COPD) patient with endoscopic polymer foam (EPF), prior to endoscopic lung volume reduction (ELVR) with valves. The aim of this study was to investigate the efficacy of this in a larger cohort and compare outcomes with a similar cohort with no CV.

Methods: Patients with severe COPD, with the left upper lobe (LUL) targeted for ELVR, were assessed for CV with high resolution computed tomography (HRCT). If fissure completeness was >95% they were enrolled as controls for valves alone (endobronchial valve control group [EBV-CTRL]). If fissure completeness was 80%-95%, defects were mapped to the corresponding segment, where EPF was instilled following confirmation of CV with CHARTIS. EBVs were inserted 1 month afterwards.

Results: Fourteen patients were enrolled into both arms. After 6 months, there were significant improvements in both groups in forced expiratory volume in 1 s (FEV1; +19.7% EPF vs. +27.7% EBV-CTRL, p < 0.05); residual volume (RV; -16.2% EPF vs. -20.1% EBV-CTRL, p = NS); SGRQ (-15.1 EPF vs. -16.6 EBV-CTRL p = NS) and 6 min walk (+25.8% EPF [77.2 m] vs. +28.4% [82.3 m] EBV-CTRL p = NS). Patients with fissural defects mapped to the lingula had better outcomes than those mapped to other segments (FEV1 +22.9% vs. +16.3% p < 0.05). There were no serious adverse reactions to EPF.

Conclusion: EPF successfully reverses CV in severe COPD patients with a left oblique fissure that is 80%-95% complete. Following EBV, outcomes are similar to patients with complete fissures undergoing ELVR with EBV alone. EPF therapy to reverse CV potentially increases the number of COPD patients suitable for ELVR with minimal adverse reactions.

Trial registration: ClinicalTrials.gov NCT05396131.

Keywords: COPD; bronchoscopy and interventional techniques; chronic obstructive pulmonary disease; collateral ventilation; endobronchial valve; endoscopic lung volume reduction; polymer foam.

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Conflict of interest statement

This is an investigator‐initiated trial funded by Pulmonx Australia. Alvin J. Ing has received consultancy fees in the past from Pulmonx Australia, Olympus Australia and Morair Medical. The other authors have made no disclosures.

Figures

FIGURE 1
FIGURE 1
Example of segmental mapping of lingula fissure defect (LB4 and LB5). Single left oblique fissure defect seen, subtended by LB5. (A) LUL segments by volume, voxel density and subtending fissure defects (single defect in LB5 segment). (B) Colour coded graphical representation of mapped segments. (C) Fissure mapping with red representing areas of fissure deficiency and green representing areas where fissures are intact
FIGURE 2
FIGURE 2
Example of segmental mapping of fissural defects (involving other segments in addition to lingula segments). Multiple defects seen in Left Oblique fissure with defects corresponding to left upper lobe apical segment/left upper lobe posterior segment (LB1/2) and lingula superior segment (LB4) and lingula inferior segment (LB5). (A) LUL segments by volume, voxel density, and subtending fissure defects (multiple defects subtended by LB 1 + 2, LB4 and LB5). (B) Colour coded graphical representation of mapped segments. (C) Fissure mapping with red representing areas of fissure deficiency and green representing areas where fissures are intact
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