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Original ResearchInterventional PulmonologyBiological Lung Volume Reduction: A New Bronchoscopic Therapy for Advanced Emphysema
Section snippets
Patient Selection Criteria
The National Emphysema Treatment Trial established subgroups of emphysema patients in whom LVRS had the greatest benefit and the least risk. These outcomes are reasonably well defined and quantitated.217 The inclusion/exclusion criteria selected for the present study are similar to those used for LVRS. We reasoned that the use of these criteria would allow us to test BLVR in a subset of patients who had been demonstrated to have an acceptable risk for LVRS and also to facilitate the comparison
Results
This study was performed at the Brigham and Women's Hospital and Caritas-St. Elizabeth's Medical Center (both in Boston, MA). Seventeen patients were screened, and the 6 men with advanced emphysema who met inclusion/exclusion criteria (mean age, 66 ± 5.7 years; age range, 57 to 73 years) were enrolled into the study. Mean baseline physiology values were as follows: FEV1, 0.99 ± 0.32 L [28 ± 8% predicted]; FVC, 3.21 ± 0.57 L [72 ± 12% predicted]; RV, 5.57 ± 0.72 L [236 ± 26% predicted]; RV/TLC
Discussion
Interventions in humans with advanced emphysema to treat hyperinflation by reducing lung volume have focused on mechanical approaches. LVRS is designed to remove 20 to 30% of the most diseased portion of total lung volume and has been demonstrated to provide significant benefit in appropriately selected patients. More recently, less invasive approaches, including bronchoscopic insertion of indwelling one-way valves into the bronchial tree to produce atelectasis distal to the valves, have been
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All of the authors were involved in patient recruitment, performing the procedure, postprocedure data collection, and reviewing the manuscript. Dr. Reilly takes responsibility for the authorship, revisions, and correspondence.
This study was funded by Aeris Therapeutics, Inc (Woburn, MA). Aeris provided funding for the clinical trial and maintained the database used to track safety and efficacy parameters. The primary data were collected by the authors and transmitted to the shared database maintained by Aeris. In addition, Aeris performed continuous audits to verify the accuracy of the reported data.
Drs. Reilly, Pinto-Plata, Washko, Velez, Kenney, and Celli have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Dr. Berger is a paid consultant to Aeris, Inc.