Chest
Original ResearchCOPDComplete Unilateral vs Partial Bilateral Endoscopic Lung Volume Reduction in Patients With Bilateral Lung Emphysema
Section snippets
Materials and Methods
In this single-center study, we prospectively included patients with severe emphysema after obtaining written consent. The study protocol had been approved by the ethics committee of the University of Heidelberg (S-288/2009).
In all patients, endoscopic lung volume reduction (ELVR) with placement of an IBV was indicated because of their severe emphysema. Heterogeneity and bilateral distribution of the emphysema was proven by native thin-slice CT (HRCT) scan and confirmed by perfusion
Results
We enrolled 23 of 73 screened patients between September 2009 and February 2010 (27.4%). One patient achieved an FEV1 of just above the inclusion criteria on the day of the procedure and, hence, had to be excluded from the study. Of the remaining 22 patients (10 women, 12 men, mean age 63.4 years, range 47-78 years) 11 were randomized into the unilateral and 11 into the bilateral group.
Both groups showed no difference in lung function, exercise tolerance, or mMRC and SGRQ score. However, Paco2
Discussion
The aim of unilateral valve treatment with complete closure of all segments of one lobe is a real volume reduction of the most hyperinflated lobe. The maximum volume effect is achieved by developing a complete lobar atelectasis. In the largest published trial on ELVR (Endobronchial Valve for Emphysema Palliation Trial [VENT]) there was an increase of 4.3% in FEV1 after 6 months in the treatment group, which was significant, but this mean change of 34.5 mL may not be clinically important for the
Conclusion
Unilateral valve placement with complete closure of a single lobe can improve lung function, exercise capacity, and QoL to a clinically relevant degree in patients with severe bilateral pulmonary emphysema. It is significantly superior to bilateral incomplete treatment. The sole improvement in SGRQ cannot justify the risk of an interventional procedure in our opinion, and, hence, a unilateral treatment should be preferred even in bilateral emphysema.
Acknowledgments
Author contributions: Dr Eberhardt is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.
Dr Eberhardt: contributed to patient selection, follow-up, and data sampling; performing the procedures; and writing and editing the manuscript.
Dr Gompelmann: contributed to patient selection, follow-up, and data sampling and writing and editing the manuscript.
Dr Schuhmann: contributed to patient selection, follow-up, and data
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Funding/Support: The authors' institution has received unrestricted grants from Olympus Europe Holding/Germany for medical education activities. The intrabronchial valves used for this trial and fees associated with the license to use the St. George Respiratory Questionnaire were provided by Olympus Medical Co, Tokyo, Japan.