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. 2025 Apr 2;34(176):240258.
doi: 10.1183/16000617.0258-2024. Print 2025 Apr.

Extrapulmonary effects of lung volume reduction in severe emphysema: a systematic review

Else A M D Ter Haar  1   2 , Dirk-Jan Slebos  3   2 , Jorine E Hartman  3   2
Affiliations

Extrapulmonary effects of lung volume reduction in severe emphysema: a systematic review

Else A M D Ter Haar et al. Eur Respir Rev. .

Abstract

Background: Lung volume reduction, either surgical or bronchoscopic, is an effective therapeutic strategy that improves pulmonary function, quality of life and exercise capacity in patients with advanced emphysema. The aim of this review was to evaluate the extrapulmonary effects of this treatment.

Methods: PubMed, Embase and Web of Science were searched until 19 August 2024. The extrapulmonary effects were classified into nine distinct domains. Studies that reported outcomes related to one of the predefined extrapulmonary domains with a follow-up duration of at least 1 month were eligible for inclusion. A descriptive summary of the effects from all studies was compiled.

Results: A total of 85 articles were included. The majority of studies were conducted in patients who underwent lung volume reduction surgery (74%). The greatest improvements were found in respiratory muscle strength, ventilatory drive, diaphragm morphology and body mass index. While the effects were less pronounced, beneficial outcomes were also observed for body composition, inflammation, oxidative stress, anxiety, depression and bone mineral density. The overall treatment effect of lung volume reduction on cardiac function and pulmonary arterial pressure was inconclusive; however, there is no evidence to suggest any significant deterioration. For the extrapulmonary domains of cognition, sleep and peripheral muscle function, evidence is currently insufficient to determine whether lung volume reduction has any impact.

Conclusion: Lung volume reduction treatment has multiple beneficial extrapulmonary effects in patients with severe emphysema and lung hyperinflation. These findings support the use of lung volume reduction as a treatment for this patient population.

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Conflict of interest statement

Conflict of interest: D-J. Slebos reports grants and consultancy paid to his institution from PulmonX, MoreAir, Nuvaira, PulmAir, FreeFlowMedical and Apreo all outside the submitted work. E.A.M.D. ter Haar and J.E. Hartman have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
FIGURE 2
FIGURE 2
Summary of risk of bias assessments using a) the revised Cochrane Risk of Bias tool (RoB2) for randomised trials and b) the Risk Of Bias In Non-randomised Studies of Interventions tool (ROBINS-I). Judgments regarding each risk of bias item are presented as percentages across all included studies.
FIGURE 3
FIGURE 3
Distribution of publications reviewed by a) study design, b) treatment type and c) domains of extrapulmonary effects. BLVR: bronchoscopic lung volume reduction; EBV: endobronchial valve; LVRS: lung volume reduction surgery; RCT: randomised controlled trial.
FIGURE 4
FIGURE 4
Schematic overview of extrapulmonary effects of lung volume reduction treatment. The domains represented in the green section of the circle indicate a positive overall effect, ranging from strongly to moderately to slightly positive, while the domains depicted in grey reflect an inconclusive overall effect. BMI: body mass index; CRP: C-reactive protein; FM: fat mass; FFM: fat-free mass; HRmax: maximal heart rate; MDA: malondialdehyde; Pdi: transdiaphragmatic pressure; PImax: maximal inspiratory pressure; REE: resting energy expenditure; STS: sit-to-stand test; WBC: white blood cell.
See this image and copyright information in PMC

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