Bronchoscopic Lung Volume Reduction
Pp. 332-355 (24)
Rabih I. Bechara
Emphysema is a form of the chronic obstructive pulmonary disease
characterized by destruction of alveolar tissue, abnormal and permanent enlargement of
the airspaces distal to the terminal bronchioles. The physiologic consequences of the
anatomical changes include loss of elastic recoil, early airway closure during
exhalation, and air trapping in the distal air spaces. Alveolar wall destruction with the
formation of emphysematous blebs and bullae leads to increased physiologic dead
space and loss of gas exchanging surface. Further, air trapping and hyperinflation press
the diaphragm into a flat configuration and place all the muscles of respiration at a
mechanical overstretch disadvantage. In combination, these mechanisms lead to
refractory dyspnea in affected individuals.
Lung volume reduction surgery (LVRS) is a surgical treatment for patients with
advanced emphysema whose dyspnea is poorly controlled with the usual therapies.
LVRS entails reducing the lung volume by wedge excisions of emphysematous tissue.
However, surgical morbidity is high, and non-pulmonary comorbidities may preclude
surgery. Minimally invasive techniques have been created, and provide similar benefits
to surgical outcomes with significantly less morbidity and mortality. Bronchoscopic
Lung Volume Reduction (BLVR) refers to techniques developed to treat hyperinflation
due to emphysema, using devices deployed via a flexible bronchoscope. The devices
and techniques for BLVR will be reviewed in this manuscript.
Airway Bypass, Coils, COPD, Emphysema, Endobronchial Valve,
Hydrogel, Lung Volume Reduction, Thermal Ablation.
Cancer Treatment Centers of America at Southeastern Regional Medical Center, Newnan, GA 30265, USA.