Abstract
Background: Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients Methods: PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers. Results: Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George's respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients'. Collateral ventilation was negative/fissure was intact (CV-/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes. Conclusion: In conclusion, EBV has favorable effects on patients' outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 224-237 |
| Number of pages | 14 |
| Journal | Journal of Bronchology and Interventional Pulmonology |
| Volume | 29 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jul 1 2022 |
Funding
Disclosure: M.M.W. is a consultant for PulmonX and Olympus. G.C. has funding for medical writing from GlaxoSmithKline. He has research grants from Alung Technologies Inc, American College of Radiology, American Lung Association, AstraZeneca, BioScale Inc, Boethringer Ingelhelm, BREATH therapeutics Inc, COPD foundation, Coridea/ZIDAN, Corvus, Dr. Karen Burns of St. Michaels Hospital, Fisher & Paykel Healthcare ltd, Galapagos NV, GlaxoSmithKline, Kinevent, Lungpacer Medical Inc., National Heart Lung and Blood Institute, Nurvaira Inc, Patient-Centered Outcomes Research Insititute, Pulmonary Fibrosis Foundation, PulmonX, Respironics Inc., Respivant Sciences, Spiration Inc., Steward St. Elizabeth’s Medical Center of Boston Inc., Veracyte Inc. He has also received personal fees from Amgen, Astrazenaca, Boehringer Ingelheim, Broncus Medical, CSA Medical, EOLO Medical, Gala Therapeutics, GlaxoSmithKline, Heilos Medical, Ion, Merck, Medtronic, Mereo BioPharma, NGM Biopharmaceuticals, Novartis, Olympus, PulmonX, Respironics Inc, Respivant Sciences, The implementation Group and Verona Pharma. For the remaining authors there are no conflict of interest or other disclosures.
Keywords
- bronchoscopic lung volume reduction
- endobronchial valves
- severe emphysema
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine