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. 2022 Jun 20;28(2):10.7196/AJTCCM.2022.v28i2.249.
doi: 10.7196/AJTCCM.2022.v28i2.249. eCollection 2022.

Position statement on endoscopic lung volume reduction in South Africa: 2022 update

C F N Koegelenberg  1 , R N van Zyl-Smit  2 , K Dheda  3 , B W Allwood  1 , M J Vorster  3 , D Plekker  4 , D-J Slebos  5 , K Klooster  5 , P L Shah  6 , F J F Herth  7 ; Assembly on Interventional Pulmonology of the South African Thoracic Society
Affiliations

Position statement on endoscopic lung volume reduction in South Africa: 2022 update

C F N Koegelenberg et al. Afr J Thorac Crit Care Med. .

Abstract

Chronic obstructive pulmonary disease (COPD) remains one of the most common causes of morbidity and mortality in South Africa. Endoscopic lung volume reduction (ELVR) was first proposed by the South African Thoracic Society (SATS) for the treatment of advanced emphysema in 2015. Since the original statement was published, there has been a growing body of evidence that a certain well-defined sub-group of patients with advanced emphysema may benefit from ELVR, to the point where the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines and the United Kingdom National Institute for Health and Care Excellence (NICE) advocate the use of endoscopic valves based on level A evidence. Patients aged 40 - 75 years with severe dyspnoea (COPD Assessment Test score ≥10) despite maximal medical therapy and pulmonary rehabilitation, with forced expiratory volume in one second (FEV1) 20 - 50%, hyperinflation with residual volume (RV) >175% or RV/total lung capacity (TLC) >55% and a six-minute walking distance (6MWD) of 100 - 450 m (post-rehabilitation) should be referred for evaluation for ELVR, provided no contraindications (e.g. severe pulmonary hypertension) are present. Further evaluation should focus on the extent of parenchymal tissue destruction on high-resolution computed tomography (HRCT) of the lungs and interlobar collateral ventilation (CV) to identify a potential target lobe. Commercially available radiology software packages and/or an endobronchial catheter system can aid in this assessment. The aim of this statement is to provide the South African medical practitioner and healthcare funders with an overview of the practical aspects and current evidence for the judicious use of the valves and other ELVR modalities which may become available in the country.

Keywords: Coils; emphysema; endoscopic lung volume reduction; valves.

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Conflict of interest statement

Conflicts of interest: FJFH, D-JS and PLS have treated patients in clinical trials, sponsored by PneumRx/BTG (USA), Pulmonx (Switzerland) and Spiration (USA). The rest of the authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Endobronchial (Zephyr) valves of varying diameters for lobar or segmental occlusion.
Fig. 2
Fig. 2
Intrabronchial (IBV) valves of varying diameters
Fig. 3
Fig. 3
An example of a high-resolution computed tomography scan of the lung with the target lobe identified. The (A) axial, (B) coronal and (C) sagittal views of an HRCT obtained from a patient who was deemed an appropriate candidate for ELVR with valves. In this case, the fissures (F) were 98% intact, with 74% destruction of the left upper lobe (ULL), which had a volume of 2 320 mL, making it the ideal target lobe.
Fig. 4
Fig. 4
A general recommended approach to ELVR in South Africa. HRCT = high-resolution computed tomography CV = collateral ventilation LVRS = lung volume reduction surgery
See this image and copyright information in PMC

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