Jorine E Hartman1, Karin Klooster2, Sonja W S Augustijn2, Wouter H van Geffen3, Justin L Garner4,5,6, Pallav L Shah4,5,6, Nick H T Ten Hacken2, Dirk-Jan Slebos2. 1. Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, j.hartman@umcg.nl. 2. Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3. Department of Pulmonary diseases, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 4. Royal Brompton Hospital, London, United Kingdom. 5. National Heart & Lung Institute, Imperial College, London, United Kingdom. 6. Chelsea & Westminster Hospital, London, United Kingdom.
Abstract
BACKGROUND: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. OBJECTIVES: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. METHODS: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. RESULTS: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. CONCLUSIONS: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
BACKGROUND: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. OBJECTIVES: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. METHODS: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. RESULTS: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. CONCLUSIONS: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
Authors: Jorine E Hartman; H Marike Boezen; Sanne Heintzbergen; Mathieu H G de Greef; Karin Klooster; Nick H T ten Hacken; Dirk-Jan Slebos Journal: Eur Respir J Date: 2012-12 Impact factor: 16.671
Authors: Karin Klooster; Nick H T Ten Hacken; Ina Franz; Huib A M Kerstjens; Eva M van Rikxoort; Dirk-Jan Slebos Journal: Respiration Date: 2014-05-28 Impact factor: 3.580
Authors: Felix J F Herth; Dirk-Jan Slebos; Gerard J Criner; Arschang Valipour; Frank Sciurba; Pallav L Shah Journal: Respiration Date: 2019-03-05 Impact factor: 3.580
Authors: M A Puhan; D Chandra; Z Mosenifar; A Ries; B Make; N N Hansel; R A Wise; F Sciurba Journal: Eur Respir J Date: 2010-08-06 Impact factor: 16.671
Authors: Isabela M B Sclauser Pessoa; Verônica Franco Parreira; Guilherme A F Fregonezi; A William Sheel; Frank Chung; W Darlene Reid Journal: Can Respir J Date: 2013-10-17 Impact factor: 2.409
Authors: Sharyn A Roodenburg; Jorine E Hartman; Gaëtan Deslée; Felix J F Herth; Karin Klooster; Frank C Sciurba; Pallav L Shah; Arschang Valipour; Zaid Zoumot; Dirk-Jan Slebos Journal: Respiration Date: 2022-04-11 Impact factor: 3.966