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Bronchoscopic lung volume reduction for pulmonary emphysema: preliminary experience with endobronchial occluder.

Abstract：

OBJECTIVE:To describe the self-expanding endobronchial occluder, as utilized in bronchoscopic lung volume reduction, with a 36 month follow-up procedure. METHODS:Twenty-three subjects with severe emphysema were recruited and underwent flexible bronchoscopic placement of self-expanding endobronchial occluders. Outcomes were assessed at 1 week, 1-month, 3-, 6-, 12-, 24-, and 36-month intervals. Feasibility, safety, and efficacy were analyzed by means of pulmonary function testing, 6-min walk test, dyspnea score, BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) index, and St George's Respiratory Questionnaire. RESULTS:Fifty-eight self-expanding endobronchial occluders were implanted into 23 lobes previously selected. No displacement was found during the follow-up. Five subjects experienced postoperative complications of cough, and 6 subjects had lobar pneumonia, which were not located in any of the blocked segments. The FEV1 in 18 subjects was improved by > 15%, compared with baselines (P < .001), and the mean first efficacy time and maximal efficacy time were 5.65 ± 1.51 months and 6.35 ± 3.08 months, respectively. No significant changes were observed in FVC or the ratio of residual volume to TLC. The 6-min walk distance, dyspnea score, and St George's Respiratory Questionnaire total score were improved in 22 subjects over a 24-month period, and a minority of subjects continued to improve through to the end of the study. Mean baseline BODE index had improved during follow-up, but not at the study's conclusion. CONCLUSIONS:This preliminary study demonstrates early significant improvements in pulmonary function, 6-min walk distance, dyspnea score, BODE index, and quality of life after placement of the self-expanding endobronchial occluder in bronchoscopic lung volume reduction. Its placement also proved both easy and safe. However, the initial improvements were maintained long-term for only a minority of subjects.

journal_name

Respir Care

journal_title

Respiratory care

authors

Song L,Zhao F,Ti X,Chen W,Wang G,Wu C,Li Y

doi

10.4187/respcare.02218

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

1351-9

issue

eissn

0020-1324

issn

1943-3654

pii

respcare.02218

journal_volume

pub_type

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Bronchoscopic lung volume reduction for pulmonary emphysema: preliminary experience with endobronchial occluder.