Chest
Original ResearchCOPDBilateral Endoscopic Sealant Lung Volume Reduction Therapy for Advanced Emphysema
Section snippets
Study Design
This was a single arm, prospective study performed at two academic-affiliated medical centers in Israel. All participants were nonsmokers (≥ 4 months) and had severe airflow obstruction, evidence of hyperinflation, clinical symptoms despite optimal medical management, and no prohibitive comorbid conditions. All participants signed an informed consent approved by the ethics committees at the participating institutions (Rabin Medical Center IRB protocol # 5975; Soroka Medical Center IRB protocol
Patient Characteristics
The majority of patients were older men (64 ± 8 years, 17 men) with significant smoking histories (34.2 ± 9.2 pack-years) and BMI values in the low-normal range (23.0 ± 4.1 kg/m2). All patients were receiving medical treatment in accordance with GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.11 Baseline physiology confirmed severe airflow obstruction (FEV1 = 1.04 ± 0.39 L, 32.7% ± 8.7% predicted; FVC = 2.89 ± 0.85 L, 69.0% ± 14.6% predicted), hyperinflation (RV = 5.12
Discussion
Results of this study indicate that bilateral ELS treatment performed at two subsegments in each upper lobe produces durable lung volume reduction in patients with advanced heterogeneous ULP and homogeneous emphysema that is associated with physiologic and functional benefit. Although the study is small and open label, improvements from baseline in objective, relatively effort-independent end points, including lobar volume reduction assessed by quantitative CT analysis, FEV1, Dlco, and RV/TLC
Acknowledgments
Author contributions: Dr Kramer is the guarantor of the manuscript and is responsible for the integrity and accuracy of the data.
Dr Kramer: contributed to data collection and analysis and manuscript preparation and review.
Dr Refealy: contributed to data collection and analysis and manuscript review.
Dr Maimon: contributed to data collection and analysis and manuscript review.
Dr Rosengarten: contributed to data collection and revision of the manuscript.
Dr Fruchter: contributed to data collection
References (12)
- et al.
Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial
J Thorac Cardiovasc Surg
(2006) - et al.
Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial
Lancet
(2011) - et al.
Improvement in spirometry following lung volume reduction surgery: application of a physiologic model
Am J Respir Crit Care Med
(2002) - et al.
Lung elastic recoil in acute and chronic asthma
Curr Opin Pulm Med
(2002) - et al.
National Emphysema Treatment Trial: the major outcomes of lung volume reduction surgery in severe emphysema
Proc Am Thorac Soc
(2008) - et al.
A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema
N Engl J Med
(2003)
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Funding/Support: This study was supported by Aeris Therapeutics, Woburn, MA.
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