Bronchoscopic Interventions in the Management of COPD
Bronchoscopic Interventions in the Management of COPD
This is a bronchoscopic technique similar in concept to biological LVR; precise doses of thermal energy are delivered as steam in the target airway. This thermal damage leads to inflammation, scarring and permanent atelectasis, thus leading to LVR. It is easy to conceptualize that again this technique is irreversible and not limited by collateral ventilation. As of now, only limited human data exist. The largest human study to date was published in 2012. It involved 44 patients with upper lobe predominant heterogeneous emphysema; the study was an open-label, single-arm, safety and efficacy trial that evaluated unilateral bronchoscopic thermal vapor ablation (BTVA). At 6 months, mean FEV1 improved by 141 ml (17%), the treated lobes shrunk on an average of 48%, and there was significant improvement in dyspnea scores. Common adverse events were respiratory in nature (COPD exacerbation, pneumonia, and hemoptysis). However, since a significant percentage of patients develop inflammatory reaction in response to thermal injury (fever, infiltrates, etc.), it is unclear how these reactions were distinguished from pneumonia or COPD exacerbation. Future studies are needed to corroborate the findings with larger sample size and a control arm. Just like with PLVR, there is no effect of fissure integrity on the efficacy of BTVA.
Bronchoscopic Thermal Vapor Ablation
This is a bronchoscopic technique similar in concept to biological LVR; precise doses of thermal energy are delivered as steam in the target airway. This thermal damage leads to inflammation, scarring and permanent atelectasis, thus leading to LVR. It is easy to conceptualize that again this technique is irreversible and not limited by collateral ventilation. As of now, only limited human data exist. The largest human study to date was published in 2012. It involved 44 patients with upper lobe predominant heterogeneous emphysema; the study was an open-label, single-arm, safety and efficacy trial that evaluated unilateral bronchoscopic thermal vapor ablation (BTVA). At 6 months, mean FEV1 improved by 141 ml (17%), the treated lobes shrunk on an average of 48%, and there was significant improvement in dyspnea scores. Common adverse events were respiratory in nature (COPD exacerbation, pneumonia, and hemoptysis). However, since a significant percentage of patients develop inflammatory reaction in response to thermal injury (fever, infiltrates, etc.), it is unclear how these reactions were distinguished from pneumonia or COPD exacerbation. Future studies are needed to corroborate the findings with larger sample size and a control arm. Just like with PLVR, there is no effect of fissure integrity on the efficacy of BTVA.
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