In:
Respiration, S. Karger AG, Vol. 101, No. 5 ( 2022), p. 476-484
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV 〈 sub 〉 1 〈 /sub 〉 ), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample 〈 i 〉 t 〈 /i 〉 tests were performed to compare means before and after intervention. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax ( 〈 i 〉 n 〈 /i 〉 = 2) or lack of benefit ( 〈 i 〉 n 〈 /i 〉 = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT −4 ± 6 points, FEV 〈 sub 〉 1 〈 /sub 〉 +190 ± 140 mL, RV −770 ± 790 mL, and +37 ± 65 m on the 6MWT (all 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.
Type of Medium:
Online Resource
ISSN:
0025-7931
,
1423-0356
Language:
English
Publisher:
S. Karger AG
Publication Date:
2022
detail.hit.zdb_id:
1464419-8
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