Bronchoscopic lung volume reduction(BLVR) is a procedure to reduce the
volume of air within the
lungs. BLVR was initially developed in the early 2000s[1][2] as a minimally invasive treatment for severe
COPD that is primarily caused by
emphysema. BLVR evolved from earlier surgical approaches first developed in the 1950s[3] to reduce lung volume by removing damaged portions of the lungs via
pneumonectomy or
wedge resection. Procedures include the use of
valves, coils, or thermal vapour ablation.[citation needed]
Procedures
BLVR involves the use of valves, coils, or thermal vapour ablation.[citation needed]
Valves
Endobronchial valves are inserted using a
bronchoscope into sections of the lungs damaged by emphysema. Endobronchial valves are
medical devices that allow air to exit these sections but not to re-enter. The valves, in effect, cause damaged lung tissue to deflate, thereby reducing the excessive lung volume (hyperinflation) caused by emphysema. Two endobronchial valves have been approved by the FDA for BLVR: Zephyr and Spiration.[citation needed]
Zephyr valve
Zephyr, manufactured by Pulmonx Corporation, obtained FDA approval in June, 2018,[4] after a clinical research trial (LIBERATE)[5] led by principal investigator Gerard Criner, MD, of Temple University Hospital.[citation needed]
In the trial, a total of 190 subjects were randomized across 24 hospital sites into two groups. One group received an endobronchial valve. The other received “standard of care” (SOC) under the current guidelines for hyperinflation due to emphysema. The trial found the endobronchial valve reduced residual lung volume and improved exercise tolerance as compared to the SOC group.[citation needed]
Spiration valve
Spiration, manufactured by Spiration, Inc., obtained FDA approval in December, 2018,[6] after a clinical trial (EMPROVE)[7] showed the valve improved pulmonary function scores among trial participants. The Spiration valve subsequently was first used in treatment by Dr. Criner at Temple University Hospital.[citation needed]
The procedure
BLVR valves are placed into the lungs using a
catheter through a bronchoscope. During the one-hour procedure, the patient receives anesthesia through an intravenous line. After the procedure, patients usually remain in the hospital for at least four days. During hospitalization, the patient receives a series of chest X-rays to monitor the position of the valves. An outpatient follow-up appointment is scheduled for seven to 10 days after the procedure. Additional imaging tests, such as X-rays, and bronchoscopies may be required[8] weeks, months or years following the initial BLVR procedure.[citation needed]
Exacerbation of COPD (occurs in as many as 14%[8] of patients)
Pneumothorax[5] (occurred in 26.6% of patients in the LIBERATE trial)
Pneumonia (occurs in as many as 9% of patients)
Valve expectoration (occurs in as many as 16% of patients)
Research
The first clinical research study of BLVR valve implantation was published in the New England Journal of Medicine in 2010.[16] Since that time, nearly 80 additional papers have been published related to the efficacy[17][18] of BLVR, inclusion criteria,[19] anesthesia management[20] during BLVR, and related topics. Key studies include:
^Fernandez-Bussy, Sebastian; Labarca, Gonzalo; Herth, Felix J. F. (2018). "Bronchoscopic Lung Volume Reduction in Patients with Severe Emphysema". Seminars in Respiratory and Critical Care Medicine. 39 (6): 685–692.
doi:
10.1055/s-0038-1676774.
ISSN1069-3424.
PMID30641586.
S2CID58559837.