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  • Online Resource  (3)
  • Gebhardt, Andreas  (3)
  • Grah, Christian  (3)
  • 1
    Online Resource
    Online Resource
    Endoscopic lung volume reduction with endobronchial valves in very low D LCO patients: results from the German Registry – Lungenemphysemregister e.V.
    European Respiratory Society (ERS) ; 2021
    In:  ERJ Open Research Vol. 7, No. 1 ( 2021-01), p. 00449-2020-
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    In: ERJ Open Research, European Respiratory Society (ERS), Vol. 7, No. 1 ( 2021-01), p. 00449-2020-
    Abstract: Endoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusing capacity of the lung for carbon monoxide ( D LCO ). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to D LCO for patients treated with ELVR. Methods We assessed D LCO at baseline and 3 months follow-up and compared pre- and postprocedural pulmonary function test, quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry. Results In total, 121 patients treated with ELVR were analysed. Thirty-four patients with a D LCO ≤20% and 87 patients with a D LCO 〉 20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p 〈 0.001 to baseline) in both groups, and both demonstrated better quality of life (p 〈 0.01 to baseline). Forced expiratory volume in 1 s (FEV 1 ) improved significantly only in patients with a D LCO 〉 20% (p 〈 0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax ( D LCO ≤20%: 17.6% versus D LCO 〉 20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups. Conclusions ELVR improves lung function as well as quality of life in patients with D LCO 〉 20% and D LCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low D LCO .
    Type of Medium: Online Resource
    ISSN: 2312-0541
    URL: Article
    DOI: 10.1183/23120541.00449-2020
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2021
    detail.hit.zdb_id: 2827830-6
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  • 2
    Online Resource
    Online Resource
    Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia
    S. Karger AG ; 2022
    In:  Respiration Vol. 101, No. 9 ( 2022), p. 823-832
    Details
    In: Respiration, S. Karger AG, Vol. 101, No. 9 ( 2022), p. 823-832
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Robust clinical evidence on the efficacy and safety of endoscopic lung volume reduction (ELVR) with one-way valves in patients with severe lung emphysema with chronic hypercapnic respiratory failure is lacking. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The aim of this study was to compare patient characteristics, clinical outcome measures, and incidences of adverse events between patients with severe COPD undergoing ELVR with one-way valves and with either a partial pressure of carbon dioxide (pCO 〈 sub 〉 2 〈 /sub 〉 ) of ≤45 mm Hg or with pCO 〈 sub 〉 2 〈 /sub 〉 & #x3e;45 mm Hg. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This was a multicentre prospective study of patients with severe lung disease who were evaluated based on lung function, exercise capacity (6-min walk test [6-MWT]), and quality-of-life tests. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Patients with pCO 〈 sub 〉 2 〈 /sub 〉 ≤45 mm Hg ( 〈 i 〉 n 〈 /i 〉 = 157) and pCO 〈 sub 〉 2 〈 /sub 〉 & #x3e;45 mm Hg ( 〈 i 〉 n 〈 /i 〉 = 40) showed similar baseline characteristics. Patients with pCO 〈 sub 〉 2 〈 /sub 〉 ≤45 mm Hg demonstrated a significant increase in forced expiratory volume in 1 s ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), a significant decrease in residual volume (RV) ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and significant improvements in the quality of life and 6-MWT at the 3-month follow-up. Patients with pCO 〈 sub 〉 2 〈 /sub 〉 & #x3e;45 mm Hg had significant improvements in RV only ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.05). There was a significant decrease in pCO 〈 sub 〉 2 〈 /sub 〉 between baseline and follow-up in hypercapnic patients, relative to the decrease in patients with pCO 〈 sub 〉 2 〈 /sub 〉 ≤45 mm Hg ( 〈 i 〉 p 〈 /i 〉 = 0.008). Patients who were more hypercapnic at baseline showed a greater reduction in pCO 〈 sub 〉 2 〈 /sub 〉 after valve placement ( 〈 i 〉 r 〈 /i 〉 = −0.38, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Pneumothorax was the most common adverse event in both groups. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 ELVR with one-way valves seems clinically beneficial with a remarkably good safety profile for patients with chronic hypercapnic respiratory failure.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000524996
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1464419-8
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  • 3
    Online Resource
    Online Resource
    Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV 1
    European Respiratory Society (ERS) ; 2023
    In:  ERJ Open Research Vol. 9, No. 4 ( 2023-07), p. 00190-2023-
    Details
    In: ERJ Open Research, European Respiratory Society (ERS), Vol. 9, No. 4 ( 2023-07), p. 00190-2023-
    Abstract: Endoscopic lung volume reduction (ELVR) with one-way valves produces beneficial outcomes in patients with severe emphysema. Evidence on the efficacy remains unclear in patients with a very low forced expiratory volume in 1 s (FEV 1 ) (≤20% predicted). We aim to compare clinical outcomes of ELVR, in relation to the FEV 1 restriction. Methods All data originated from the German Lung Emphysema Registry (Lungenemphysem Register), which is a prospective multicentric observational study for patients with severe emphysema after lung volume reduction. Two groups were formed at baseline: FEV 1 ≤20% pred and FEV 1 21–45% pred. Pulmonary function tests (FEV 1 , residual volume, partial pressure of carbon dioxide), training capacity (6-min walk distance (6MWD)), quality of life (modified Medical Research Council dyspnoea scale (mMRC), COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ)) and adverse events were assessed and compared at baseline and after 3 and 6 months. Results 33 patients with FEV 1 ≤20% pred and 265 patients with FEV 1 21–45% pred were analysed. After ELVR, an increase in FEV 1 was observed in both groups (both p 〈 0.001). The mMRC and CAT scores, and 6MWD improved in both groups (all p 〈 0.05). The SGRQ score improved significantly in the FEV 1 21–45% pred group, and by trend in the FEV 1 ≤20% pred group. Pneumothorax was the most frequent complication within the first 90 days in both groups (FEV 1 ≤20% pred: 7.7% versus FEV 1 21–45% pred: 22.1%; p=0.624). No deaths occurred in the FEV 1 ≤20% pred group up to 6 months. Conclusion Our study highlights the potential efficacy of one-way valves, even in patients with very low FEV 1 , as these patients experienced significant improvements in FEV 1 , 6MWD and quality of life. No death was reported, suggesting a good safety profile, even in these high-risk patients.
    Type of Medium: Online Resource
    ISSN: 2312-0541
    URL: Article
    DOI: 10.1183/23120541.00190-2023
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2023
    detail.hit.zdb_id: 2827830-6
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    Online Resource
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