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Collateral ventilation and selection of techniques for bronchoscopic lung volume reduction
  1. Pallav L Shah1,2,3,
  2. Duncan M Geddes1
  1. 1Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, UK
  3. 3National Heart & Lung Institute, Imperial College, London, UK
  1. Correspondence to Dr Pallav Shah, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; pallav.shah{at}

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Lung volume reduction can give substantial benefit to selected patients with emphysema. However, the high morbidity associated with surgery has fuelled the development of bronchoscopic lung volume reduction. Investment in research has primarily focused on the development of endobronchial valves. Three large randomised controlled trials with endobronchial valves have only shown marginal clinical benefit overall, although some patients had significant improvement in pulmonary function.1–3 Cohort studies have also demonstrated a survival benefit in patients who developed lobar atelectasis.4 5 Collateral ventilation appears to be the key factor that limits the effectiveness of endobronchial valves.6 Support for this theory has been enhanced by subgroup analysis of the Endobronchial Valve for Emphysema Palliation Trial (VENT) study, which has shown the greatest improvements in lung function (17.9% improvement in forced expiratory volume in 1 s [FEV1] at 12 months) in patients who had evidence of an intact fissure on the treatment side providing the endobronchial valves were correctly positioned.1 The absence of any clinical benefit in patients …

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  • Competing interests PS has been involved in a number of clinical trials on bronchoscopic lung volume reduction and the host centres (Royal Brompton Hospital and the Chelsea & Westminster Hospital) have been reimbursed for clinical trial expenses. There are no competing interests with respect to the emphysematous lung sealant (AeriSeal®). DM has no competing interests.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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