Interventional Bronchoscopy in the Management of Chronic Obstructive Lung Disease

Author(s): Semra Bilaçeroğlu*.

Journal Name: Current Respiratory Medicine Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation and reduced gas exchange that lead to progressive dyspnea. Pulmonary rehabilitation, lifestyle changes, pharmacotherapy, long-term oxygen therapy, noninvasive ventilation and surgical therapeutic approaches are the basic management strategies.

Purpose: In the last 15 years, various bronchoscopic therapeutic modalities have emerged for severe COPD. The aim of this review is to summarize the effects of these bronchoscopic treatments compared with lung rehabilitation and pharmacological therapies.

Methods: A PubMed search for the eligible studies and reviews on interventional bronchoscopy and COPD has been conducted.

Results: Bronchoscopic lung volume reduction (LVR) techniques are targeted to reduce hyperinflation. The efficacy of reversible valve implantation has been confirmed in several randomized controlled trials. It provides clinical benefit in the absence of interlobar collateral ventilation. Nonblocking bronchoscopic LVR with coils, thermal vapor or sealants is independent of collateral ventilation but has not been studied sufficiently. Partially irreversible coil implantation leads to parenchymal compression while irreversible LVR with thermal vapor or sealants induce an inflammatory reaction. Targeted lung denervation ablates parasympathetic pulmonary nerves in COPD for sustainable bronchodilation, and liquid nitrogen metered cryospray destroys hyperplastic goblet cells and excessive submucous glands in the central airways to induce mucosal regeneration in chronic bronchitis.

Conclusion: The best-examined bronchoscopic LVR method is the valve therapy. The data from the other modalities are still limited. Further studies are required to select the patients that will optimally benefit from a particular treatment and to predict and treat the procedure-related complications.

Keywords: Chronic bronchitis, chronic obstructive pulmonary disease, cryotherapy, emphysema, interventional bronchoscopy, lung volume reduction, targeted lung denervation.

[1]
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease 2019 https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-POCKET-GUIDE-FINAL_WMS.pdf (date of access: 27.11.2018)
[2]
Casanova C, Cote C, de Torres JP, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171: 591-7.
[3]
Mahler DA, O’Donnell DE. Recent advances in dyspnea. Chest 2015; 147: 232-41.
[4]
O’Donnell DE, Laveneziana P. The clinical importance of dynamic lung hyperinflation in COPD. COPD 2006; 3: 219-32.
[5]
van Geffen WH, Slebos DJ, Kerstjens HA. Hyperinflation in COPD exacerbations. Lancet Respir Med 2015; 3: e43-4.
[6]
Moore AJ, Soler RS, Cetti EJ, et al. Sniff nasal inspiratory pressure versus IC/TLC ratio as predictors of mortality in COPD. Respir Med 2010; 104: 1319-25.
[7]
O’Donnell DE, Laveneziana P. Dyspnea and activity limitation in COPD: Mechanical factors. COPD 2007; 4: 225-36.
[8]
Cooper CB. The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006; 119: 21-31.
[9]
Guenette JA, Webb KA, O’Donnell DE. Does dynamic hyperinflation contribute to dyspnoea during exercise in patients with COPD? Eur Respir J 2012; 40: 322-9.
[10]
Dretzke J, Moore D, Dave C, et al. The effect of domiciliary noninvasive ventilation on clinical outcomes in stable and recently hospitalized patients with COPD: A systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2016; 11: 2269-86.
[11]
Gompelmann D, Sarmand N, Herth FJF. Interventional pulmonology in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2017; 23: 261-8.
[12]
Brantigan OC, Mueller E. Surgical treatment of pulmonary emphysema. Am Surg 1957; 23: 789-804.
[13]
Criner GJ, Cordova FC, Furukawa S, et al. Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160: 2018-27.
[14]
Geddes D, Davies M, Koyama H, et al. Effect of lung-volume-reduction surgery in patients with severe emphysema. N Engl J Med 2000; 343: 239-45.
[15]
O’Donnell DE, Webb KA, Bertley JC, Chau LK, Conlan AA. Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. Chest 1996; 110: 18-27.
[16]
van Geffen WH, Slebos DJ. Autobullectomy in patients with COPD. Respiration 2015; 89: 88.
[17]
Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003; 348: 2059-73.
[18]
Beckers F, Lange N, Koryllos A, Picchioni F, Windisch W, Stoelben E. Unilateral lobe resection by video-assisted thoracoscopy leads to the most optimal functional improvement in severe emphysema. Thorac Cardiovasc Surg 2016; 64: 336-42.
[19]
Pompeo E, Tacconi F, Mineo TC. Comparative results of non-resectional lung volume reduction performed by awake or non-awake anesthesia. Eur J Cardiothorac Surg 2011; 39: e51-8.
[20]
Sciurba FC, Ernst A, Herth FJ, et al. VENT Study Research Group. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 2010; 363: 1233-44.
[21]
Herth FJ, Noppen M, Valipor A, et al. International VENT Study Group. Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort. Eur Respir J 2012; 39: 1334-42.
[22]
Ninane V, Geltner C, Bezzi M, et al. Multicentre European study for the treatment of advanced emphysema with bronchial valves. Eur Respir J 2012; 39: 1319-25.
[23]
Davey C, Zoumut Z, Jordan S, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BelLieVeR-HIFi study): A randomised controlled trial. Lancet 2015; 386: 1066-73.
[24]
Klooster K, ten Hacken NH, Hartman JE, et al. Endobronchial valves for emphysema without interlobar collateral ventilation. N Engl J Med 2015; 373: 2325-35.
[25]
Valipour A, Slebos DJ, Herth F, et al. IMPACT Study Team. Endobronchial valve therapy in patients with homogeneous emphysema. Results from the IMPACT Study. Am J Respir Crit Care Med 2016; 194: 1073-82.
[26]
Slebos DJ, Cicenia J, Sciurba FC, Criner GJ, Hartman JE, Garner J, et al. RENEW Study Group. Predictors of response to endobronchial coil therapy in patients with advanced emphysema. Chest 2019; 155(5): 928-37.
[27]
Deslee G, Klooster K, Hetzel M, et al. Lung volume reduction coil treatment for patients with severe emphysema: A European multicenter trial. Thorax 2014; 69: 980-6.
[28]
Polke M, Rötting M, Sarmand N, et al. Interventional therapy in patients with severe emphysema: evaluation of contraindications and their incidence. Ther Adv Respir Dis 2019; 131753466619835494
[http://dx.doi.org/10.1177/1753466619835494]
[29]
Come CE, Kramer MR, Dransfield MT, et al. A randomized trial of lung sealant versus medical therapy for advanced emphysema. Eur Respir J 2015; 46: 651-62.
[30]
Herth FJ, Valipour A, Shah PL, et al. Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicenter, parallel-group, open-label, randomized controlled STEP-UP trial. Lancet Respir Med 2016; 4: 185-93.
[31]
Bakeer M, Abdelgawad TT, El-Metwaly R, El-Morsi A, El-Badrawy MK, El-Sharawy S. Low cost biological lung volume reduction therapy for advanced emphysema. Int J Chron Obstruct Pulmon Dis 2016; 11: 1793-800.
[32]
Refaely Y, Dransfield M, Kramer MR, et al. Biologic lung volume reduction therapy for advanced homogeneous emphysema. Eur Respir J 2010; 36: 20-7.
[33]
Shah PL, Slebos DJ, Cardoso PF, et al. Bronchoscopic lung-volume reduction with exhale airway stents for emphysema (EASE trial): Randomised, sham-controlled, multicentre trial. Lancet 2011; 378: 997-1005.
[34]
van Geffen WH, Kerstjens HAM, Slebos DJ. Emerging bronchoscopic treatments for chronic obstructive pulmonary disease. Pharmacol Ther 2017; 179: 96-101.
[35]
Gompelmann D, Eberhardt R, Slebos DJ, et al. Diagnostic performance comparison of the Chartis System and high-resolution computerized tomography fissure analysis for planning endoscopic lung volume reduction. Respirology 2014; 19: 524-30.
[36]
Schuhmann M, Raffy P, Yin Y, et al. Computed tomography predictors of response to endobronchial valve lung reduction treatment: comparison with Chartis. Am J Respir Crit Care Med 2015; 191: 767-74.
[37]
Herzog D, Poellinger A, Doellinger F, et al. Modifying post-operative medical care after EBV implant may reduce pneumothorax incidence. PLoS One 2015; 10 e0128097
[38]
Trudzinski FC, Höink AJ, Leppert D, et al. Endoscopic lung volume reduction using endobronchial valves in patients with severe emphysema and very low FEV1. Respiration 2016; 92: 258-65.
[39]
Gompelmann D, Herth FJF, Slebos DJ, et al. Pneumothorax following endobronchial valve therapy and its impact on clinical outcomes in severe emphysema. Respiration 2014; 87: 485-91.
[40]
Hopkinson NS, Kemp SV, Toma TP, et al. Atelectasis and survival after bronchoscopic lung volume reduction for COPD. Eur Respir J 2011; 37: 1346-51.
[41]
Venuta F, Anile M, Diso D, et al. Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J 2012; 39: 1084-9.
[42]
Kontogianni K, Gerovasili V, Gompelmann D, et al. Effectiveness of endobronchial coil treatment for lung volume reduction in patients with severe heterogeneous emphysema and bilateral incomplete fissures: a six-month follow-up. Respiration 2014; 88: 52-60.
[43]
Herth FJ, Eberhard R, Gompelmann D, Slebos DJ, Ernst A. Bronchoscopic lung volume reduction with a dedicated coil: A clinical pilot study. Ther Adv Resp Dis 2010; 4: 225-31.
[44]
Slebos DJ, Klooster K, Ernst A, Herth FJ, Kerstjens HA. Bronchoscopic lung volume reduction coil treatment of patients with severe heterogeneous emphysema. Chest 2012; 142: 574-82.
[45]
Shah PL, Zoumot Z, Singh S, et al. Endobronchial coils for the treatment of severe emphysema with hyperinflation (RESET): A randomised controlled trial. Lancet Respir Med 2013; 1: 233-40.
[46]
Deslee G, Mal H, Dutau H, et al. Lung volume reduction coil treatment vs. usual care in patients with severe emphysema: The REVOLENS randomized clinical trial. JAMA 2016; 315: 175-84.
[47]
Sciurba FC, Criner GJ, Strange C, et al. Effect of endobronchial coils vs. usual care on exercise tolerance in patients with severe emphysema: The RENEW randomized clinical trial. JAMA 2016; 315: 2178-89.
[48]
Shah PL, Herth FJ, van Geffen WH, Deslee G, Slebos DJ. Lung volume reduction for emphysema. Lancet Respir Med 2017; 5: 147-56.
[49]
Gompelmann D, Eberhardt R, Schuhmann M, et al. Lung volume reduction with vapor ablation in the presence of incomplete fissures: a 12-month results from the STEP-UP Randomized Controlled Study. Respiration 2016; 92: 397-403.
[50]
Snell GI, Hopkins P, Westall G, et al. A feasibility and safety study of bronchoscopic thermal vapor ablation: A novel emphysema therapy. Ann Thorac Surg 2009; 88: 1993-8.
[51]
Snell G, Herth FJ, Hopkins P, et al. Bronchoscopic thermal vapor ablation therapy in the management of heterogeneous emphysema. Eur Respir J 2012; 39: 1326-33.
[52]
Herth FJ, Gompelmann D, Stanzel F, et al. Treatment of advanced emphysema with emphysematous lung sealant. [AeriSeal(R)] Respiration 2011; 82: 36-45.
[53]
Criner GJ, Pinto-Plata V, Strange C, et al. Biologic lung volume reduction in advanced upper lobe emphysema: Phase 2 results. Am J Respir Crit Care Med 2009; 179: 791-8.
[54]
Slebos DJ, Klooster K, Koegelenberg CF, et al. Targeted lung denervation for moderate to severe COPD: a pilot study. Thorax 2015; 70: 411-9.
[55]
Coad JE, Bischof JC. Histologic differences between cryothermic and hyperthermic therapies. In: Ryan TP, Ed. Thermal treatment of tissue: energy delivery and assessment II. Proceedings of Biomedical Optics (volume 4954); 2003: San Jose, CA, U.S.: Society of Photo-Optical Instrumentation Engineers (SPIE); 2003; pp. 27-36.
[56]
Godwin BL, Coad JE. Healing responses following cryothermic and hyperthermic tissue ablation. In: Ryan TP, Ed. Energy-based treatment of tissue and assessment V. Proceedings of SPIE BiOS (. volume 7181); 2009: San Jose, CA, U.S.: Society of Photo-Optical Instrumentation Engineers (SPIE);. 2009: p; p. : 7181 03
[57]
Slebos DJ, Shah PL, Herth FJF, Valipour A. Endobronchial valves for endoscopic lung volume reduction: Best practice recommendations from expert panel on endoscopic lung volume reduction. Respiration 2017; 93: 138-50.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 2
Year: 2019
Page: [133 - 139]
Pages: 7
DOI: 10.2174/1573398X15666190211155026

Article Metrics

PDF: 17
HTML: 2
PRC: 1