Lung volume reduction for emphysema.
Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited effects. Surgical resection of the most destroyed sections of the lung can improve pulmonary function and exercise capacity but its benefit is tempered by significant morbidity. This issue stimulated a search for novel approaches to lung volume reduction. Alternative minimally invasive approaches using bronchoscopic techniques including valves, coils, vapour thermal ablation, and sclerosant agents have been at the forefront of these developments. Insertion of endobronchial valves in selected patients could have benefits that are comparable with lung volume reduction surgery. Endobronchial coils might have a role in the treatment of patients with emphysema with severe hyperinflation and less parenchymal destruction. Use of vapour thermal energy or a sclerosant might allow focal treatment but the unpredictability of the inflammatory response limits their current use. In this Review, we aim to summarise clinical trial evidence on lung volume reduction and provide guidance on patient selection for available therapies.
The National Institute for Health Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London UK. Electronic address: pallav.shah@imperial.ac.uk.
Pallav L
PL
Shah
Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg, Germany; Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany.
Felix J
FJ
Herth
The National Institute for Health Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK; Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Wouter H
WH
van Geffen
Department of Pulmonary Medicine, INSERM U903, University Hospital of Reims, Reims, France.
Gaetan
G
Deslee
Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Dirk-Jan
DJ
Slebos
D001999:Bronchoscopy / Q000379:methods*; D004646:Emphysema / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012123:Pulmonary Ventilation; D016896:Treatment Outcome