title: Effect of fissure integrity on lung volume reduction using a polymer sealant in advanced emphysema.
abstract: BACKGROUND
  Interlobar fissure integrity has previously correlated with responsiveness to endobronchial lung volume reduction therapy in patients with advanced emphysema.
  
  
  OBJECTIVE
  This report summarises the effect of interlobar fissure integrity on responses to treatment with a novel endoscopic tissue sealant (AeriSeal emphysematous lung sealant (ELS)) that collapses hyperinflated lung.
  
  
  METHODS
  Fissure status, lung volumes, tissue density and disease heterogeneity were assessed radiographically in 28 patients (age 63.4±6.1 years, 20 men) with advanced upper lobe predominant emphysema (density=888.0±18.2 HU; upper lobe tissue density < -950 = 2.62±1.74). Post-treatment changes in lobar volume, pulmonary function, exercise capacity, symptoms and quality of life were compared in patients with complete fissures (CFs) and incomplete fissures (ICFs).
  
  
  RESULTS
  ELS therapy reduced lung volumes independent of interlobar fissure integrity. In patients with upper lobe emphysema and CFs, lobar volume reduction was 214±127 ml/treatment compared with 256±175 ml/treatment in those with ICFs (p=0.453). Reductions in gas trapping and improvements in spirometry, functional capacity and quality of life were similar in patients with CFs and ICFs. Stepwise multiple regression modelling confirmed that fissure integrity did not contribute to post-treatment changes in forced expiratory volume in 1 s, residual volume/total lung capacity ratio or lobar volume measured by CT analysis.
  
  
  CONCLUSIONS
  Interlobar fissure integrity, an important determinant of responsiveness to endobronchial lung volume reduction therapy in prior studies, had minimal impact on physiological and functional responses to ELS therapy in patients with severe upper lobe predominant emphysema.
  
  
  BACKGROUND
  Registration numbers for trials contributing to datasets in this report: NCT00884962, NCT01051258 and NCT01181466.
authors.affiliation: Pulmonary Research Institute at Hospital Groβhansdorf, Center for Pneumology and Thoracic Surgery, Groβhansdorf, Groβhansdorf 22927, Germany. magnussen@pulmoresearch.de
authors.forename: Helgo
authors.initials: H
authors.lastname: Magnussen
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Kirsten
authors.forename: Charles
authors.initials: C
authors.lastname: Marquette
authors.forename: Arschang
authors.initials: A
authors.lastname: Valipour
authors.forename: Franz
authors.initials: F
authors.lastname: Stanzel
authors.forename: Reiner
authors.initials: R
authors.lastname: Bonnet
authors.forename: Juergen
authors.initials: J
authors.lastname: Behr
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.forename: Yael
authors.initials: Y
authors.lastname: Refaely
authors.forename: Ralf
authors.initials: R
authors.lastname: Eberhardt
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004724:Endoscopy / Q000379:methods*; D005060:Europe; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011142:Polyvinyl Alcohol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012984:Software; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C562023:AeriSeal; D011142:Polyvinyl Alcohol