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A 52-year-old man with chronic obstructive pulmonary disease GOLD 4, group D, and severe, heterogeneous pulmonary emphysema (figure 1) and marked hyperinflation was treated with bronchoscopic lung volume reduction (LVR) using endobronchial valves (EBVs) and, 6 months thereafter, bilateral thoracoscopic lung volume reduction surgery (LVRS), both after multidisciplinary team consensus. The interventions individually resulted in a clear but only short-term success due to rapid progression of emphysema and hyperinflation. After EBV treatment, forced expiratory volume in one second (FEV1) improved from 0.86 L (23% predicted) to 1.16 L (31% predicted), and residual volume (RV) improved from 5.14 L (219% predicted) to 4.93 L (210%). Only 4 months thereafter, FEV1 dropped to 0.68 L (18%), while RV increased to 5.84 L (266% predicted). At 3 months after LVRS, FEV1 increased again to 0.87 L (23% predicted), and RV decreased to 5.40 L (227% predicted). However, chest CT revealed progressive emphysematous changes, and the patient experienced increasing dyspnoea again. Negligible …
Contributors TMB, RS, DS, JHR and DF wrote the paper. TMB contributed figure 1. JHR contributed figure 2.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.