Bronchoscopic interventions for severe emphysema: Where are we now?
TLDR
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.read more
Citations
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Airway granulation response to lung-implantable medical devices: a concise overview.
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References
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Journal ArticleDOI
A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.
Alfred P. Fishman,Fernando J. Martinez,Keith S. Naunheim,Steven Piantadosi,Robert A. Wise,Andrew L. Ries,Gail Weinmann,Douglas E. Wood +7 more
TL;DR: Overall, lung-volume-reduction surgery increases the chance of improved exercise capacity but does not confer a survival advantage over medical therapy, although it does yield a survival advantages for patients with both predominantly upper-lobe emphysema and low base-line exercise capacity.
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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019.
Dave Singh,Alvar Agusti,Antonio Anzueto,Peter J. Barnes,Jean Bourbeau,Bartolome R. Celli,Gerard J. Criner,Peter Frith,David M.G. Halpin,MeiLan K. Han,M. Victorina López Varela,Fernando J. Martinez,Maria Montes de Oca,Alberto Papi,Ian D. Pavord,Nicolas Roche,Don D. Sin,Robert A. Stockley,Jørgen Vestbo,Jadwiga A. Wedzicha,Claus Vogelmeier +20 more
TL;DR: Blood eosinophils are recommended as a biomarker to support clinical decisions regarding the use of inhaled corticosteroids in chronic obstructive pulmonary disease patients, based on recent evidence from clinical trials.
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Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease
Joel D. Cooper,Elbert P. Trulock,Anastasios N. Triantafillou,G.A. Patterson,Mary S. Pohl,P.A. Deloney,R. S. Sundaresan,Charles L. Roper +7 more
TL;DR: Surgical bilateral lung volume reduction may be of significant value for selected patients with severe chronic obstructive pulmonary disease and marked relief of dyspnea and improvement in exercise tolerance and quality of life.
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A randomized study of endobronchial valves for advanced emphysema.
Frank C. Sciurba,Armin Ernst,Felix J.F. Herth,Charlie Strange,Gerard J. Criner,Charles H. Marquette,Kevin L. Kovitz,Richard P. Chiacchierini,Jonathan G. Goldin,Geoffrey McLennan +9 more
TL;DR: Endobronchial-valve treatment for advanced heterogeneous emphysema induced modest improvements in lung function, exercise tolerance, and symptoms at the cost of more frequent exacerbations of COPD, pneumonia, and hemoptysis after implantation.
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Patients at high risk of death after lung-volume-reduction surgery
Alfred P. Fishman,Henry Fessler,Fernando J. Martinez,Robert McKenna,Keith S. Naunheim,Steven Piantadosi,Gail Weinmann,Robert A. Wise +7 more
TL;DR: Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphySEma or a very low carbon monoxide diffusing capacity, and these patients are at high risk for death after surgery and also are unlikely to benefit from the surgery.