title: An update on bronchoscopic treatments for chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The last decade has seen a real drive to develop novel bronchoscopic tools for diagnosis and therapy in a number of disease areas, in particular in cancer diagnosis and the treatment of airways disease. Nowhere has this been more evident than in the field of chronic obstructive pulmonary disease/emphysema.
  
  
  RESULTS
  The clinical trials with randomized endobronchial valves (EBVs) have demonstrated significant improvements in pulmonary function, quality of life and exercise capacity providing patients with heterogeneous disease with absence of collateral ventilation are selected. The responder rates are improved by valve adjustment or replacement where necessary. The results for endobronchial coils have been mixed with clinically meaningful results for pulmonary function and quality of life but at 1 year, the benefits in walk tests have been marginal. Vapour therapy appears promising and has the capacity for more targeted and staged therapy. Other therapies such as sealants which induce focal fibrosis, targeted vagal nerve ablation and cryoablation of bronchitis mucosa are also under development.
  
  
  CONCLUSIONS
  Patients with severe heterogenous emphysema, evidence of hyperinflation and intact lobar fissures confirmed to have absent collateral ventilation may be considered for EBVs. Those with collateral ventilation or homogenous distribution of emphysema may be considered for endobronchial coils.
authors.affiliation: aThe National Institute for Health Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and Imperial College bChelsea and Westminster Hospital NHS Foundation Trust, London UK.
authors.forename: Samuel V
authors.initials: SV
authors.lastname: Kemp
authors.forename: Pallav L
authors.initials: PL
authors.lastname: Shah
mesh_terms: D001982:Bronchial Diseases / Q000175:diagnosis*; D001999:Bronchoscopy / Q000379:methods; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000503:physiopathology; D011013:Pneumonectomy / Q000379:methods; D011788:Quality of Life; D012129:Respiratory Function Tests