title: Lobar Collapse Therapy Using Endobronchial Valves as a New Complementary Approach to Treat Cavities in Multidrug-Resistant Tuberculosis and Difficult-to-Treat Tuberculosis: A Case Series.
abstract: BACKGROUND
  The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches.
  
  
  OBJECTIVE
  We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment. This report describes the feasibility, effectiveness and safety of the procedure.
  
  
  METHODS
  Patients with severe lung destruction, one or more cavities or those who were ineligible for surgical resection and showed an unsatisfactory response to standard drug treatments were enrolled. During bronchoscopy, endobronchial valves were implanted in the lobar or segmental bronchi in order to induce atelectasis and reduce the cavity size.
  
  
  RESULTS
  Four TB patients and 1 patient with atypical mycobacteriosis were treated. The mean patient age was 52.6 years. Complete cavity collapses were observed on CT scans in 4 of the 5 cases. All patients showed improvements in their clinical status, and sputum smears became negative within 3-5 months. There were no severe short- or long-term complications. The valves were removed in 3 of the 5 patients after 8 months on average; there was no relapse after 15 months of follow-up.
  
  
  CONCLUSIONS
  These data suggest that endobronchial valves are likely to be useful adjuncts to the treatment of therapeutically difficult patients. More data are required to confirm our findings.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Corbetta
authors.forename: Ariela
authors.initials: A
authors.lastname: Tofani
authors.forename: Flavio
authors.initials: F
authors.lastname: Montinaro
authors.forename: Lucio
authors.initials: L
authors.lastname: Michieletto
authors.forename: Loris
authors.initials: L
authors.lastname: Ceron
authors.forename: Chiara
authors.initials: C
authors.lastname: Moroni
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Rogasi
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001999:Bronchoscopy / Q000379:methods*; D003096:Collapse Therapy / Q000266:history / Q000379:methods*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000628:therapy*; D011031:Pneumothorax, Artificial / Q000266:history / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D014397:Tuberculosis, Pulmonary / Q000266:history / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents