title: Bronchoscopic thermal vapour ablation therapy in the management of heterogeneous emphysema.
abstract: The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema. 44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40-75 yrs, forced expiratory volume in 1 s (FEV(1)) 15-45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) ≥ 1.2. Changes in FEV(1), St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6 MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA. At 6 months, mean ± SE FEV(1) improved by 141 ± 26 mL (p<0.001) and residual volume was reduced by 406 ± 113 mL (p<0.0001). SGRQ total score improved by 14.0 ± 2.4 points (p<0.001), with 73% improving by ≥ 4 points. Improvements were observed in 6 MWD (46.5 ± 10.6 m) and mMRC dyspnoea score (0.9 ± 0.2) (p<0.001 for both). Lower respiratory events (n=11) were the most common adverse event and occurred most often during the initial 30 days. BTVA therapy results in clinically relevant improvements in lung function, quality of life and exercise tolerance in upper lobe predominant emphysema.
authors.affiliation: Allergy Immunology and Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia. g.snell@alfred.org.au
authors.forename: Gregory
authors.initials: G
authors.lastname: Snell
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: Peter
authors.initials: P
authors.lastname: Hopkins
authors.forename: Kimberley M
authors.initials: KM
authors.lastname: Baker
authors.forename: Christian
authors.initials: C
authors.lastname: Witt
authors.forename: Mark H
authors.initials: MH
authors.lastname: Gotfried
authors.forename: Arschang
authors.initials: A
authors.lastname: Valipour
authors.forename: Manfred
authors.initials: M
authors.lastname: Wagner
authors.forename: Franz
authors.initials: F
authors.lastname: Stanzel
authors.forename: Jim J
authors.initials: JJ
authors.lastname: Egan
authors.forename: Steven
authors.initials: S
authors.lastname: Kesten
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D004417:Dyspnea / Q000601:surgery; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery*; D011788:Quality of Life; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D016896:Treatment Outcome