Endoscopic lung volume reduction in chronic obstructive airway disease using one-way valves.

Year 2017, Volume: 2 Issue: 1, 36 - 45, 16.04.2017

Konstantina Kontogianni Ralf Eberhardt

Abstract

   Chronic obstructive airway
disease (COPD) is a progressive, irreversible and debilitating disease causing
lung hyperinflation. Apart from smoking cessation and conventional medical
treatment, lung volume reduction surgery (LVRS) has been used for several years
but it involves a major thoracic surgery with high incidence of postoperative
complications. In the past decade, different approaches of minimally invasive
endoscopic lung volume reduction (ELVR) have been developed which differ in
indication, mechanism of action, reversibility and are divided into two groups:
blocking and non-blocking devices.

   The endobronchial valves
belong to the group of blocking devices available and have the largest series
of treated patients. These one way valves are used to occlude the most
emphysematous and hence destroyed lobe of the lung. Two different types of
valves are available on the market: endobronchial valves (EBV, Zephyr valves)
and intrabronchial valves (IBV, Spiration valves). They differ in shape but
have a similar mechanism of action.

   In order to improve the outcome of the ELVR using
valves, dedicated screening involving pulmonary function and exercise capacity
testing as well as qualitative and quantitative CT analysis and perfusion scan
are necessary. Numerous studies in the past years have shown the efficacy and
complications following valve therapy. It has been demonstrated that patients
with complete fissures show a more pronounced benefit and a significant target
lobe volume reduction. Furthermore, unilateral implantation aiming at obtaining
complete lobar occlusion has been more effective than the bilateral incomplete
treatment. Regarding possible complications, apart from pneumothorax, COPD
exacerbations, hemoptysis and valve migrations have been reported.

   Summarizing, in comparison
to LVRS, ELVR using valves is a less invasive alternative with the opportunity
to improve shortness of breath, exercise capacity, and quality of life in the
patients, who have reached the end of their conventional treatment options.

Keywords

obstructive pulmonary disease, emphysema, volume reduction, endobronchial valves

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