CHEST pulmonary · 2024
Bronchoscopic Lung Volume Reduction: Effect on Symptoms and Lung Function in Patients With Emphysema Who Qualify for Lung Transplant.
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Franco-Palacios Domingo J, Priebe Rebecca, Simanovski Jane, Allenspach Lisa L, Stagner Lisa, Waynick Lisa K, Wang Yichu, Lu Mei, Desai Shraddha, Kapadia Daniel, Cohen Avi
Аннотация
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.
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.