Recent advances in bronchoscopic lung volume reduction for severe COPD patients

• Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients wit

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Keyword

bronchoscopic lung volume reduction

chronic obstructive pulmonary disease

emphysema

Publication and Content Type

ref (subject category)

art (subject category)