Rein Posthuma1,2,3, Anouk W Vaes1, Kim H M Walraven2,3, Peyman Sardari Nia4, Jan U Schreiber5, Hester A Gietema6,7, Geertjan Wesseling3, Emiel F M Wouters1,8, Lowie E G W Vanfleteren9,10. 1. Department of Research and Development, Ciro, Horn, The Netherlands. 2. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. 3. Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. 4. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 5. Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands. 7. GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands. 8. Ludwig Boltzmann Institute for Lung Health, Vienna, Austria. 9. Department of Respiratory Medicine and Allergology, COPD Centre, Sahlgrenska University Hospital, Gothenburg, Sweden. 10. Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Abstract
BACKGROUND: 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. OBJECTIVES: 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. METHOD: 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 (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. RESULTS: 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 (n = 2) or lack of benefit (n = 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, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVES: 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. METHOD: 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 (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. RESULTS: 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 (n = 2) or lack of benefit (n = 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, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. CONCLUSION: 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.
Authors: Wouter H van Geffen; Karin Klooster; Jorine E Hartman; Nick H T Ten Hacken; Huib A M Kerstjens; Rienhart F E Wolf; Dirk-Jan Slebos Journal: Respiration Date: 2017-06-22 Impact factor: 3.580
Authors: D Geddes; M Davies; H Koyama; D Hansell; U Pastorino; J Pepper; P Agent; P Cullinan; S J MacNeill; P Goldstraw Journal: N Engl J Med Date: 2000-07-27 Impact factor: 91.245
Authors: Dirk Skowasch; Andreas Fertl; Björn Schwick; Harald Schäfer; Andreas Hellmann; Felix J F Herth Journal: Respiration Date: 2016-08-24 Impact factor: 3.580