Efficacy and Safety of Bronchoscopic Lung Volume Reduction With Endobronchial Valves: A Systematic Review and Meta-analysis

Abstract

Introduction

Emphysema is a phenotype of chronic obstructive pulmonary disease (COPD) that causes air trapping and lung hyperinflation and, consequently, dyspnea, reduced exercise tolerance, and poor health-related quality of life. Several randomized controlled clinical trials have shown that bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) achieves clinically relevant improvements in dyspnea, pulmonary function, exercise capacity and quality of life 12 months after valve implantation in patients with heterogeneous emphysema without collateral ventilation. The goal of our meta-analysis is to examine the efficacy and safety of BLRV in patients with COPD.

Material and methods

A literature search was performed with PubMed, Embase and Cochrane to identify randomized controlled trials on BLVR with endobronchial valves published from 2005 onwards.

Results

Nine studies with a total of 1352 patients were included; 827 received EBV therapy and 525 standard of care (SOC) medications. The first group showed statistically significant improvements in forced expiratory volume in 1 second (FEV1), Saint George Respiratory Questionnaire (SGRQ) score, modified medical research council (mMRC) dyspnea scale, and 6-minute walk distance (6MWD), and a statistically significant reduction in residual volume (RV). The incidence of pneumothorax and exacerbations in the EBV arm increase significantly, and there were no significant difference between mortality rates.

Conclusions

Patients with heterogeneous emphysema and no collateral ventilation showed significant improvements in lung function, exercise capacity, dyspnea score, and health-related quality of life after BLVR-EBV, although the risk of exacerbations and pneumothorax in the first 6 months increased compared with the group receiving standard care.