title: The Role of Lobe Selection on FEV1 Response in Endobronchial Valve Therapy.
abstract: Endobronchial valve (EBV) therapy has shown improvement in symptoms and lung function despite limited understanding of ideal patient selection. The impact of lobe selection on EBV therapy is unclear. We performed a retrospective analysis to determine the role of lobe selection and identify preprocedure predictors of response to EBV therapy. A total of 492 patients from the USA and Europe were randomized to EBV or control therapy. Spirometry and functional measurements were taken at baseline and 12 months later. At 365 days patients undergoing EBV therapy showed improvement in FEV1 change compared to control regardless of treatment to upper or lower. There was no difference in FEV1 change between the upper and lower lobe treatment groups ( 5 .99, 7.04, p = 0.75). In addition lobe selection was not identified as a significant modifier of FEV1 change in multiple linear regression analysis. Complete lobe fissure was the only significant predictor of FEV1 change (OR 4.14 (2.29, 7.47)). Our results suggest that lobe selection does not play a major role in EBV therapy response. Complete fissure status preprocedure has the greatest influence on FEV1 improvement. These results have implications on patient selection for current treatment and in future EBV studies.
authors.affiliation: a Department of Internal Medicine , Lewis Katz School of Medicine at Temple University , Philadelphia , PA , USA.
authors.forename: Cole
authors.initials: C
authors.lastname: Liberator
authors.affiliation: b Department of Thoracic Medicine and Surgery , Lewis Katz School of Medicine at Temple University , Philadelphia , PA , USA.
authors.forename: Kartik
authors.initials: K
authors.lastname: Shenoy
authors.affiliation: b Department of Thoracic Medicine and Surgery , Lewis Katz School of Medicine at Temple University , Philadelphia , PA , USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Marchetti
authors.affiliation: b Department of Thoracic Medicine and Surgery , Lewis Katz School of Medicine at Temple University , Philadelphia , PA , USA.
authors.forename: Gerard
authors.initials: G
authors.lastname: Criner
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D005060:Europe; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019919:Prosthesis Implantation; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013147:Spirometry; D016896:Treatment Outcome; D014481:United States
keywords: bronchoscopy; chronic obstructive; prostheses and implants; pulmonary disease; pulmonary emphysema/complications; pulmonary emphysema/therapy