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Sadie Khorramnia

Bio: Sadie Khorramnia is an academic researcher from Alfred Hospital. The author has contributed to research in topics: Pneumothorax & Spirometry. The author has an hindex of 1, co-authored 2 publications receiving 6 citations.

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TL;DR: The creation and maintenance of a transthoracic pneumostoma appears feasible and safe in patients with severe emphysema and was associated with potentially useful long-term improvements or stability in spirometry, residual volume, and QoL.
Abstract: Background: Emphysema is characterised by airflow obstruction, hyperinflation, and resultant dyspnoea. It is worth investigating whether decompression improves lung mechanics and enhances quality of life (QoL). Objectives: The purpose of this study was to describe the feasibility and safety of creating a transthoracic pneumostoma to enable lung reduction. Methods: A transthoracic 10-mm diameter Portaero Access Tube (Portaero™, Cupertino, CA, USA) was implanted via a third intercostal space incision in 15 severe emphysema patients [mean age 63 years, forced expiratory volume in 1 s 54% predicted, diffusing capacity for carbon monoxide 31% predicted, residual volume 246% predicted, Six-Minute Walk Test 296 m]. Four weeks later, an 8-mm Portaero Disposable Tube (3-8 cm in length) was substituted and changed daily thereafter. The targeted primary endpoints were a ≥12% increase in forced expiratory volume in 1 s and a decrease of ≥4 points in Saint George's Respiratory Questionnaire score at 6 months. Results: Sixteen procedures were performed on 15 patients, complicated by 1 intercostal haemorrhage, 1 pneumothorax, and universal mild surgical emphysema. Early patency issues were common, but often responded to external endoscopic debridement or argon plasma laser. Three-month patency was achieved in 9 of 15 patients, and 6 of these had long-term patency (mean of 4 years). Patency was associated with potentially useful long-term improvements or stability in spirometry, residual volume, and QoL. However, the primary endpoints were not met at 6 months. Conclusion: The creation and maintenance of a transthoracic pneumostoma appears feasible and safe in patients with severe emphysema. Further studies refining patient selection (perhaps via chest computed tomography collateral ventilation and fissure assessments), techniques, and tube materials are suggested.

5 citations

Journal ArticleDOI
TL;DR: A case initially referred for lung transplantation is presented, where sequential left upper lobe BLVR and 7 years later right upper lobe SLVR are presented, providing enduring physiological and functional improvement.
Abstract: Bronchoscopic Lung Volume Reduction (BLVR) and Surgical Lung Volume Reduction (SLVR) and are two different approaches used to remodel severely emphysematous lungs to improve lung function and quality-of-life. We present a case initially referred for lung transplantation, where sequential left upper lobe BLVR and 7 years later right upper lobe SLVR, providing enduring physiological and functional improvement. The potential for sustained benefit via sequential unilateral lung volume reduction is under-appreciated.

1 citations


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TL;DR: This review discusses bronchoscopic approaches for emphysema treatment which has progressed through clinical trials to clinical practice.
Abstract: Patients with severe emphysema have limited treatment options and only derive a small benefit from optimal medical treatment. The only other therapy to have significant clinical beneficial effect in emphysema is LVRS but the perceived risk and invasiveness of surgery has fuelled bronchoscopic approaches to induce lung volume reduction. There are multiple bronchoscopic methods for achieving volume reduction in severe emphysema: EBV, airway bypass procedure, endobronchial coils, thermal (vapour) sclerosis and chemical sclerosis (sealants). Optimal patient selection is key to successful patient outcomes. This review discusses bronchoscopic approaches for emphysema treatment which has progressed through clinical trials to clinical practice.

16 citations

Journal ArticleDOI
TL;DR: It is found that only a small proportion of patients that are referred forBLVR treatment is eligible for a BLVR treatment, indicating a need for both better referral tools and for the development of new therapies for this group of patients.
Abstract: Purpose: Bronchoscopic lung volume reduction (BLVR) is a valuable treatment option for carefully selected patients with severe COPD. There is limited knowledge about the characteristics and outcomes of patients referred to a specialized center for BLVR. The study objectives were to investigate the selection rate for BLVR treatment in patients referred for this treatment and to investigate the differences between patients that were selected for BLVR and patients that were not. Patients and Methods: We performed a retrospective analysis of patients with severe COPD who were referred to our hospital to assess eligibility for BLVR treatment. Our parameters included demographics, comorbidity, chest computed tomography characteristics, reasons for rejection from BLVR treatment and patient survival. Results: In total, 1500 patients were included (mean age 62 years, 50% female and forced expiratory volume in 1 s 33% of predicted). Out of this group, 282 (19%) patients were selected for BLVR treatment. The absence of a suitable target lobe for treatment, an unsuitable disease phenotype and insufficient lung hyperinflation were the most important factors for not being selected. Patients that were selected for any BLVR option lived significantly longer than the group of patients that were not selected for BLVR (median 3060 versus 2079 days, P<0.001). Conclusion: We found that only a small proportion of patients that are referred for BLVR treatment is eligible for a BLVR treatment, indicating a need for both better referral tools and for the development of new therapies for this group of patients. Furthermore, our data suggest that selection for BLVR is associated with a significant survival benefit.

9 citations

Journal ArticleDOI
TL;DR: For this patient group, both endobronchial coils as well as sclerosing therapies have shown potential as treatment options and collateral ventilation seems the most important denominator in both chronic obstructive pulmonary disease and in bronchoscopic lung volume reduction.
Abstract: dependently of this physiological phenomenon. For this patient group, both endobronchial coils [7, 8] as well as sclerosing therapies [9–11] have shown potential as treatment options. Collateral ventilation thus seems the most important denominator in both chronic obstructive pulmonary disease and in bronchoscopic lung volume reduction. Where there is a dominant chronic obstructive pulmonary disease component, there is mucosal inflammation, bronchospasm, irregular airways, and mucus plugging. In this situation, the resistance of the airways is usually high leading to progressive air trapping, hypoxemia and hypercapnia. With progressive emphysema, there is destruction of the alveolar parenchyma increasing both intraand interlobar collateral ventilation. Very early studies in excised emphysematous lungs confirmed that the resistance to collateral flow is much lower than the resistance in the airways [12] . This allows the exchange of gas even in obstructed segments and may account for the relative preservation of hypoxemia in emphysema patients. In the past, several attempts have been made to take advantage of the abundant presence of collateral ventilation in severe emphysema by creating fenestrations – a so-called “airway bypass” – between the areas of trapped air and places where this air can easily be released. Early Over the past decade, significant improvements have been made in developing nonpharmacological interventions to enhance lung mechanics in patients with severe emphysema [1] . Collateral ventilation has been an influential factor for some of the therapies and is defined as ventilation of the alveoli via pathways that bypass the normal bronchial airways. The initial randomized controlled trials with endobronchial valves failed to demonstrate clinically meaningful results as a proportion of the treated patients had collateral ventilation and hence did not develop lobar atelectasis [2] . Once the role of collateral ventilation was appreciated and patients were more carefully selected on the basis of formal measurements, remarkable benefits have been observed with mean improvements in FEV 1 between 20 and 25% [3–5] . Such is the importance of collateral ventilation that surrogate markers for collateral ventilation such as fissure integrity are formally assessed on the computed tomography scans at the screening stage and in the majority of patients formal measurements of collateral ventilation are performed by the Chartis procedure as recommended by the latest Best Practice Guidelines [6] . A significant proportion of patients with emphysema have collateral ventilation and hence alternative bronchoscopic techniques have been developed that work inPublished online: January 26, 2017

6 citations

Journal ArticleDOI
TL;DR: This work is distributed under the terms of the License http://creativecommons.org/licenses/by-nc/3.0/.
Abstract: License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php International Journal of COPD Publish your work in this journal

4 citations