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Bronchoscopic Lung Volume Reduction in Severe Emphysema

¹ Brigham and Women's Hospital, Boston, Massachusetts; ² University of Washington, Seattle, Washington; and ³ Mayo Foundation, Rochester, Minnesota

Correspondence and requests for reprints should be addressed to Edward P. Ingenito, M.D., Ph.D., Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Room CA-318, 75 Francis Street, Boston, MA 02115. E-mail: eingenito{at}partners.org

ABSTRACT

Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated with significant morbidity, mortality, and cost, nonsurgical alternatives for achieving volume reduction have been developed. Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise and reached later-stage clinical trials. These include the following: (1) placement of endobronchial one-way valves designed to promote atelectasis by blocking inspiratory flow; (2) formation of airway bypass tracts using a radiofrequency catheter designed to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggest that all three techniques are reasonably safe. However, efficacy signals have been substantially smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short- and longer-term effectiveness of these approaches are ongoing. Results will be available over the next few years and will determine whether BLVR represents a safe and effective alternative to LVRS.

Key Words: bronchoscopic lung volume reduction • endobronchial valves • airway bypass

Related articles in Proceedings of the American Thoracic Society:

Physiologic Basis for Improved Pulmonary Function after Lung Volume Reduction

Henry E. Fessler, Steven M. Scharf, Edward P. Ingenito, Robert J. McKenna, Jr., and Amir Sharafkhaneh
Proceedings of the American Thoracic Society 2008 5: 416-420. [Abstract] [Full Text]  

This article has been cited by other articles:

				H. E. Fessler, S. M. Scharf, E. P. Ingenito, R. J. McKenna Jr., and A. Sharafkhaneh Physiologic Basis for Improved Pulmonary Function after Lung Volume Reduction Proceedings of the ATS, May 1, 2008; 5(4): 416 - 420. [Abstract] [Full Text] [PDF]