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Chronic obstructive pulmonary disease
Original article
Lung volume reduction coil treatment for patients with severe emphysema: a European multicentre trial
  1. Gaëtan Deslee1,
  2. Karin Klooster2,
  3. Martin Hetzel3,
  4. Franz Stanzel4,
  5. Romain Kessler5,
  6. Charles-Hugo Marquette6,
  7. Christian Witt7,
  8. Stefan Blaas8,
  9. Wolfgang Gesierich9,
  10. Felix J F Herth10,
  11. Juergen Hetzel11,
  12. Eva M van Rikxoort12,
  13. Dirk-Jan Slebos2
  1. 1Department of Pulmonary Medicine, University Hospital of Reims, Reims, France
  2. 2Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Krankenhaus vom Roten Kreuz, Stuttgart, Germany
  4. 4Lungenklinik, Hemer, Germany
  5. 5Department of Pulmonary Medicine, University Hospital of Strasbourg, Strasbourg, France
  6. 6Department of Pulmonary Medicine, University Hospital of Nice, Nice, France
  7. 7Campus Charité Mitte, Berlin, Germany
  8. 8Donaustauf Hospital, Center for Pneumology, Donaustauf, Germany
  9. 9Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
  10. 10Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
  11. 11University Hospital, Tübingen, Germany
  12. 12Diagnostic Image Analysis Group, Department of Radiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
  1. Correspondence to Dr Dirk-Jan Slebos, Department of Pulmonary diseases AA11, University Medical Center Groningen, University of Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands; d.j.slebos{at}umcg.nl

Abstract

Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial in patients with severe emphysema.

Methods Patients were treated in 11 centres. Safety was evaluated by recording all adverse events, efficacy by the St George's Respiratory Questionnaire (SGRQ) as primary endpoint, and pulmonary function testing, modified Medical Research Council dyspnoea score (mMRC) and 6-min walk distance (6MWD) up to 12 months after the final treatment.

Results Sixty patients (60.9 ± 7.5 years, forced expiratory volume in 1 s (FEV1) 30.2 ± 6.3% pred) were bronchoscopically treated with coils (55 bilateral, 5 unilateral), with a median of 10 (range 5–15) coils per lobe. Within 30 days post-treatment, seven chronic obstructive pulmonary disease exacerbations (6.1%), six pneumonias (5.2%), four pneumothoraces (3.5%) and one haemoptysis (0.9%) occurred as serious adverse events. At 6 and 12 months, respectively, ΔSGRQ was −12.1±12.9 and −11.1±13.3 points, Δ6MWD was +29.7±74.1 m and +51.4±76 m, ΔFEV1 was +0.11±0.20 L and +0.11±0.30 L, and ΔRV (residual volume) was −0.65±0.90 L and −0.71±0.81 L (all p<0.01). Post hoc analyses showed significant responses for SGRQ, 6MWD and RV in patients with both heterogeneous and homogeneous emphysema.

Conclusions LVR coil treatment results in significant clinical improvements in patients with severe emphysema, with a good safety profile and sustained results for up to 1 year.

Trial registration number: NCT01328899.

  • Emphysema
  • Bronchoscopy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/thoraxjnl-2014-205221

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