Minimally invasive endoscopic treatment of emphysema could provide palliation with less risk than lung volume reduction surgery and offer therapy to patients currently not considered for lung volume reduction surgery. The Intrabronchial Valve is used to block bronchial airflow in the most emphysematous areas of lung.
Methods
Patients with severe chronic obstructive pulmonary disease and heterogeneous upper lobe–predominant emphysema were eligible. Patients underwent flexible bronchoscopic placement of valves into segmental or subsegmental airways in both upper lobes. Outcomes assessed over a minimum of 6 months of follow-up included the safety, feasibility, tolerance, and success of valve placement; health-related quality of life; exercise capacity; pulmonary function; and gas exchange.
Results
Five centers treated 30 patients. Patient follow-up ranged from 1 to 12 months. A mean of 6.1 valves were placed per patient. Valves were positioned by means of flexible bronchoscopy in 99% of desired airways, and the procedure duration ranged from 15 to 125 minutes (mean, 65 minutes). Hospital discharge occurred within 2 days in 27 of 30 patients. There were no deaths or episodes of valve migration, tissue erosion, or significant bleeding. Eighty-three percent of patients had no adverse events judged probably or definitely related to the device. Patients experienced significant improvement in health-related quality of life, although the physiologic and exercise outcomes did not show statistically significant improvements.
Conclusions
These first multicenter results with the Intrabronchial Valve demonstrate significant improvements in health-related quality of life and acceptable safety, ease of use, and procedural complication rates. The valve might be a safer and less-invasive alternative to surgical therapy for patients with severe emphysema.
CTSNet classification
11
Abbreviations and Acronyms
COPD
chronic obstructive pulmonary disease
IBV
Intrabronchial Valve
LVRS
lung volume reduction surgery
NETT
National Emphysema Treatment Trial
SGRQ
St George’s Respiratory Questionnaire
Cited by (0)
The members of the Spiration research group are listed in Appendix 1.
This clinical trial was sponsored and funded by Spiration, Inc, Redmond, Wash, the manufacturer of the intrabronchial valve tested. Xavier Gonzalez and Steven Springmeyer are Spiration employees and report stock ownership in Spiration. Atul Mehta reports lecture fees from Alveolus. Daniel Sterman reports consulting fees from Spiration and Alveolus. Douglas Wood reports consulting fees and grant support from Spiration. Roger Yusen reports consulting fees from Spiration.