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Transbronchoscopic Pulmonary Emphysema Treatment^*

1-Month to 24-Month Endoscopic Follow-up

^* From the Departments of Thoracic Surgery (Drs. de Oliveira and Macedo-Neto), Pulmonology (Drs. John and Menna-Barreto), Radiology (Dr. Jungblut), Pathology (Dr. Prolla), and Anesthesiology (Dr. Fortis), Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Correspondence to: Hugo G. de Oliveira, MD, PhD, Department of Thoracic Surgery, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2050 MI CEP, 90035-004 Porto Alegre, RS, Brazil; e-mail: hugo{at}oliveira.com

Abstract

Objective: Describe the results of a 1- to 24-month follow-up of individuals undergoing transbronchoscopic placement of one-way valves.

Design: Longitudinal, noncomparative study.

Setting: University hospital.

Patients: Nineteen heterogeneous emphysema patients.

Measurements and results: Pulmonary function testing, imaging examination, and videobronchoscopy were performed at 1, 3, 6, 12, and 24 months after the insertion of one-way valves. Mean age was 67.63 ± 8.71 years, mean body mass index (BMI) was 24.02 ± 2.65, and mean exposure to smoking was 65.32 ± 27.46 pack-years (± SD). Baseline BODE index (BMI, degree of airflow obstruction and dyspnea, exercise capacity as measured by the 6-min walk test [6MWT]) was 7 to 10 in 10 patients (estimated 4-year mortality, 80%) and 5 to 6 in 9 patients (estimated 4-year mortality, 40%). Sixty-four valves were inserted. There was no procedure-related mortality. Nonsustained atelectasis was observed within 48 h in 2 of 12 patients with right upper lobe occlusion. Fifty-six bronchoscopic examinations were performed in 24 months. Granulomas not requiring treatment were the main complication. Mucus clogging the valve, mainly at 1 month, was easily cleaned. Eighteen patients completed the 1- and 3-month follow-ups, 14 patients completed the 6-month follow-up, 11 patients completed the 12-month follow-up, and 5 patients completed the 24-month follow-up. Improvement was observed in the 6MWT after 1 month (p = 0.028) and in the BODE index at 3 months (p = 0.002). FEV₁ or FVC improvement 12% or 150 mL was observed, respectively, in 4 of 18 patients and 8 of 18 patients at 1 month, 4 of 18 patients and 7 of 18 patients at 3 months, and in 3 of 14 patients and 5 of 14 patients at 6 months. After 24 months, one of five patients and three of five patients, respectively, retained an FEV₁ and FVC change 12% or 150 mL. Significant improvement (decrease 4%) in the St. George Respiratory Questionnaire was observed at 3 months and 6 months in three of four domains.

Conclusion: Endobronchial valves are safe, but the criteria to measure improvement and to select patients should be refined. Atelectasis should be reconsidered as primary treatment goal.

Key Words: atelectasis • bronchoscopy • pulmonary emphysema • therapeutics