Bronchoscopic Lung Volume Reduction

Background

Many bronchoscopic lung volume reduction (BLVR) studies have excluded patients meeting the listing criteria for lung transplantation (LT).

Research Question

What are the outcomes of BLVR in a sicker group of patients with emphysema compared with patients not meeting the criteria for LT listing?

Study Design and Methods

This was a real-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. FEV₁, FVC, diffusing capacity for carbon monoxide, symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months after BLVR.

Results

Of 76 fully evaluated patients (median age, 62 years; 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, P < .001), higher BODE Index score (6.79 ± 1.11, P = .001), and lower FEV₁ (617.5 ± 139.2 mL, P = .005). All patients treated with BLVR experienced a decrease in BODE Index and Borg dyspnea by scores −0.5 to −2 points, respectively. Diffusing capacity for carbon monoxide % predicted increased by 4.5%, FEV₁ increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV₁ at 45 days after BLVR increased by 180.8 ± 231 mL (FEV₁ % predicted 5.84 ± 5.66) compared with baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18 of 30). Median hospital length of stay was 3.27 ± 3.07 days. Endobronchial valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10 of 42; 5 in each group).

Interpretation

Improvement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.