RT Journal Article
SR Electronic
T1 Bronchoscopic thermal vapour ablation therapy in the management of heterogeneous emphysema
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1326
OP 1333
DO 10.1183/09031936.00092411
VO 39
IS 6
A1 Gregory Snell
A1 Felix J.F. Herth
A1 Peter Hopkins
A1 Kimberley M. Baker
A1 Christian Witt
A1 Mark H. Gotfried
A1 Arschang Valipour
A1 Manfred Wagner
A1 Franz Stanzel
A1 Jim J. Egan
A1 Steven Kesten
A1 Armin Ernst
YR 2012
UL http://erj.ersjournals.com/content/39/6/1326.abstract
AB The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema. 44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40–75 yrs, forced expiratory volume in 1 s (FEV1) 15–45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) ≥1.2. Changes in FEV1, St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA. At 6 months, mean±se FEV1 improved by 141±26 mL (p<0.001) and residual volume was reduced by 406±113 mL (p<0.0001). SGRQ total score improved by 14.0±2.4 points (p<0.001), with 73% improving by ≥4 points. Improvements were observed in 6MWD (46.5±10.6 m) and mMRC dyspnoea score (0.9±0.2) (p<0.001 for both). Lower respiratory events (n=11) were the most common adverse event and occurred most often during the initial 30 days. BTVA therapy results in clinically relevant improvements in lung function, quality of life and exercise tolerance in upper lobe predominant emphysema.