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      Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey

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          ABSTRACT

          BACKGROUND:

          Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm.

          OBJECTIVES:

          Compare our experience with valve and coil BLVR devices.

          DESIGN:

          Retrospective.

          SETTING:

          Single tertiary care centre.

          PATIENTS AND METHODS:

          Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded.

          MAIN OUTCOME MEASURES:

          Change in PFTs and completion of the 6MWT.

          SAMPLE SIZE:

          60 Turkish men with a diagnosis of chronic pulmonary lung disease.

          RESULTS:

          Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients ( P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients ( P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups.

          CONCLUSION:

          Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema.

          LIMITATIONS:

          Relatively small sample, retrospective design, single-centre retrospective study.

          CONFLICT OF INTEREST:

          None.

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          Most cited references41

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          Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group.

          WA Conway, EO Coates, PA Kvale (1980)
          At six centers, 203 patients with hypoxemic chronic obstructive lung disease were randomly allocated to either continuous oxygen (O2) therapy or 12-hour nocturnal O2 therapy and followed for at least 12 months (mean, 19.3 months). The two groups were initially well matched in terms of physiological and neuropsychological function. Compliance with each oxygen regimen was good. Overall mortality in the nocturnal O2 therapy group was 1.94 times that in the continuous O2 therapy group (P = 0.01). This trend was striking in patients with carbon dioxide retention and also present in patients with relatively poor lung function, low mean nocturnal oxygen saturation, more severe brain dysfunction, and prominent mood disturbances. Continuous O2 therapy also appeared to benefit patients with low mean pulmonary artery pressure and pulmonary vascular resistance and those with relatively well-preserved exercise capacity. We conclude that in hypoxemic chronic obstructive lung disease, continuous O2 therapy is associated with a lower mortality than is nocturnal O2 therapy. The reason for this difference is not clear.
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            A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation.

            David Weill, Christian Benden, Paul Corris … (2015)
            The appropriate selection of lung transplant recipients is an important determinant of outcomes. This consensus document is an update of the recipient selection guidelines published in 2006. The Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT) organized a Writing Committee of international experts to provide consensus opinion regarding the appropriate timing of referral and listing of candidates for lung transplantation. A comprehensive search of the medical literature was conducted with the assistance of a medical librarian. Writing Committee members were assigned specific topics to research and discuss. The Chairs of the Writing Committee were responsible for evaluating the completeness of the literature search, providing editorial support for the manuscript, and organizing group discussions regarding its content. The consensus document makes specific recommendations regarding the timing of referral and of listing for lung transplantation. These recommendations include discussions not present in previous ISHLT guidelines, including lung allocation scores, bridging to transplant with mechanical circulatory and ventilator support, and expanded indications for lung transplantation. In the absence of high-grade evidence to support decision making, these consensus guidelines remain part of a continuum of expert opinion based on available studies and personal experience. Some positions are immutable. Although transplant is rightly a treatment of last resort for end-stage lung disease, early referral allows proper evaluation and thorough patient education. Subsequent waiting list activation implies a tacit agreement that transplant offers a significant individual survival advantage. It is both the challenge and the responsibility of the transplant community globally to ensure organ allocation maximizes the potential benefits of a scarce resource, thereby achieving that advantage.
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              Small-airway obstruction and emphysema in chronic obstructive pulmonary disease.

              John E McDonough, Ren Yuan, Masaru Suzuki … (2011)
              The major sites of obstruction in chronic obstructive pulmonary disease (COPD) are small airways (<2 mm in diameter). We wanted to determine whether there was a relationship between small-airway obstruction and emphysematous destruction in COPD. We used multidetector computed tomography (CT) to compare the number of airways measuring 2.0 to 2.5 mm in 78 patients who had various stages of COPD, as judged by scoring on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale, in isolated lungs removed from patients with COPD who underwent lung transplantation, and in donor (control) lungs. MicroCT was used to measure the extent of emphysema (mean linear intercept), the number of terminal bronchioles per milliliter of lung volume, and the minimum diameters and cross-sectional areas of terminal bronchioles. On multidetector CT, in samples from patients with COPD, as compared with control samples, the number of airways measuring 2.0 to 2.5 mm in diameter was reduced in patients with GOLD stage 1 disease (P=0.001), GOLD stage 2 disease (P=0.02), and GOLD stage 3 or 4 disease (P<0.001). MicroCT of isolated samples of lungs removed from patients with GOLD stage 4 disease showed a reduction of 81 to 99.7% in the total cross-sectional area of terminal bronchioles and a reduction of 72 to 89% in the number of terminal bronchioles (P<0.001). A comparison of the number of terminal bronchioles and dimensions at different levels of emphysematous destruction (i.e., an increasing value for the mean linear intercept) showed that the narrowing and loss of terminal bronchioles preceded emphysematous destruction in COPD (P<0.001). These results show that narrowing and disappearance of small conducting airways before the onset of emphysematous destruction can explain the increased peripheral airway resistance reported in COPD. (Funded by the National Heart, Lung, and Blood Institute and others.).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Saudi Med
                Journal ID (iso-abbrev): Ann Saudi Med
                Journal ID (publisher-id): asm
                Title: Annals of Saudi Medicine
                Publisher: King Faisal Specialist Hospital and Research Centre
                ISSN (Print): 0256-4947
                ISSN (Electronic): 0975-4466
                Publication date (Print): November-December 2020
                Publication date (Electronic): 03 December 2020
                Volume: 40
                Issue: 6
                Pages: 469-476 (pp. 469-476)
                Affiliations
                [a ] From the Department of Chest Surgery, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
                [b ] From the Department of Chest Surgery, Acibadem Hospitals Group, Kayseri, Turkey
                [c ] From the Department of Pulmonology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
                Author notes
                Correspondence: Dr. Ahmet Dumanli ∙ Afyonkarahisar University of Health Sciences, Afyonkarahisar 03000, Turkey ∙ ahmet_dumanli@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0002-5768-7830
                Article
                Publisher ID: 0256-4947.2020.469
                DOI: 10.5144/0256-4947.2020.469
                PMC ID: 7733646
                PubMed ID: 33307740
                SO-VID: 4f066690-46a0-41c4-8168-20e9da12b9e0
                Copyright © Copyright © 2020, Annals of Saudi Medicine, Saudi Arabia
                License:

                This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). The details of which can be accessed at http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Date received : 09 July 2020
                Date accepted : 25 September 2020
                Funding
                None.
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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