Sequential Bilateral Bronchoscopic Lung Volume Reduction for Residual Hyperinflation Following Successful Index Procedure in Pulmonary Emphysema: A Multicenter Study.

Abstract

Background: Bronchoscopic lung volume reduction (BLVR) improves pulmonary function and exercise capacity in select patients with emphysema, but some remain symptomatic with residual hyperinflation. We assessed the safety and effectiveness of bilateral BLVR in such cases.

Methods: We retrospectively analyzed patients across 2 centers who underwent BLVR in the contralateral lung after successful BLVR in the index lung, with residual hyperinflation.

Results: Thirteen patients [5 males; mean age 68; interquartile range (IQR)=64 to 73 y] underwent sequential bilateral BLVR. The median interval between index and contralateral BLVR was 16 (IQR=12-21) months, and the median length of overall follow-up following the index procedure was 22 (IQR=13-27) months. At baseline, the mean forced expiratory volume in 1 second (FEV1) was 33±9% of predicted, FEV1/forced vital capacity (FVC) ratio 39±6%, total lung capacity (TLC) 131±16%, residual volume (RV) 221±43%, RV/TLC ratio 67±10%, diffusion capacity for carbon monoxide (DLCO) 34±10%, and 6-minute walk test (6MWT) 297±72 m, with 7 (54%) patients requiring supplemental oxygen. Following bilateral BLVR, patients experienced significant improvements in RV (-52%, P=0.014), TLC (-13%, P=0.047), RV/TLC ratio (-13%, P=0.017), and DLCO (+6%, P=0.016). There were no significant long-term changes in FEV1, FEV1/FVC ratio, 6MWT, or oxygen requirement. Pneumothorax occurred in 1 (8%) and 2 (15%) patients after index and contralateral BLVR, respectively.

Conclusion: In patients with marked residual hyperinflation despite successful index BLVR, sequential bilateral BLVR appears relatively safe and moderately effective over an ∼2-year timespan.