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A spring in your lung
Bronchoscopic lung volume reduction is very much a hot topic. Hitherto coils have been positioned for contraceptive purposes somewhat distal to the lungs; so are the Gynaecologists making a Putin-like bid for our territory? This month we publish 12-month outcomes after bronchoscopic insertion of a nitinol coil device in patients with emphysema (Hot topic; see page 980). Coils have potential advantages over other techniques as their spring like effect might address loss of elasticity (is there a whole body coil for your editors?) and dynamic airway collapse; they are applicable in the 60% of patients with interlobular collateral ventilation; and they can be inserted via a fibreoptic flexible bronchoscope in sedated patients (although patients participating in this trial had general anaesthetic). The trial reports reasonable safety, with problems probably relating as much to the bronchoscopy as to the technique. A large and sustained effect on quality of life score was seen, somewhat disproportionate to the effect on lung function. Interpretation of uncontrolled trials such as this is problematic as the placebo effect is much …