Atelectasis and survival after bronchoscopic lung volume reduction for COPD.
Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery (LVRS) or to be used in patient groups in whom LVRS is not appropriate. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in patients with emphysema. The benefit is most pronounced in, though not confined to, patients where lobar atelectasis has occurred. Few data exist on their long-term outcome. 19 patients (16 males; mean±sd forced expiratory volume in 1 s 28.4±11.9% predicted) underwent BLVR between July 2002 and February 2004. Radiological atelectasis was observed in five patients. Survival data was available for all patients up to February 2010. None of the patients in whom atelectasis occurred died during follow-up, whereas eight out of 14 in the nonatelectasis group died (Chi-squared p=0.026). There was no significant difference between the groups at baseline in lung function, quality of life, exacerbation rate, exercise capacity (shuttle walk test or cycle ergometry) or computed tomography appearances, although body mass index was significantly higher in the atelectasis group (21.6±2.9 versus 28.4±2.9 kg·m(-2); p<0.001). The data in the present study suggest that atelectasis following BLVR is associated with a survival benefit that is not explained by baseline differences.
NIHR Respiratory Disease Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital Campus, London, SW3 6NP, UK. n.hopkinson@ic.ac.uk
N S
NS
Hopkinson
S V
SV
Kemp
T P
TP
Toma
D M
DM
Hansell
D M
DM
Geddes
P L
PL
Shah
M I
MI
Polkey
D015992:Body Mass Index; D001999:Bronchoscopy; D005080:Exercise Test; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology; D011013:Pneumonectomy; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011788:Quality of Life; D011859:Radiography; D016896:Treatment Outcome