J Korean Med Sci.  2014 Oct;29(10):1404-1410. 10.3346/jkms.2014.29.10.1404.

Efficacy of Bronchoscopic Lung Volume Reduction by Endobronchial Valves in Patients with Heterogeneous Emphysema: Report on the First Asian Cases

• Park TS
• Hong Y
• Lee JS
• Lee SM
• Seo JB
• Oh YM
• Lee SD
• Lee SW

• KMID: 2129632
• DOI: http://doi.org/10.3346/jkms.2014.29.10.1404

Abstract

Although many patients with severe emphysema have benefited from bronchoscopic lung volume reduction (BLVR) worldwide, experience of BLVR in Asian emphysema patients is scarce. Between July 2012 and March 2013, seven patients with advanced heterogeneous emphysema underwent BLVR in the Asan Medical Center. They had severe dyspnea and poor lung function (Modified Medical Research Council dyspnea scale 3-4; median forced expiratory volume in 1 sec [FEV1], 0.59 L [19.0 % predicted]; median 6-min walk distance [6MWD], 195 m). Endobronchial valves were inserted into the target lobe which was most hyperinflated and least perfused, and had no collateral ventilation with other lobes. Six patients showed clinical improvement after 1 month. Of them, 2 patients improved to dyspnea scale 1 and 4 patients did to scale 2 (P = 0.026). The median FEV1 increased from 0.59 to 0.89 L (51%; P = 0.028) and the median 6MWD increased from 195 to 252 m (29.2%; P = 0.028). Two patients developed a pneumothorax (one requiring drainage) and one patient experienced slight hemoptysis; however, there were no other serious adverse events. BLVR is effective in Asian advanced emphysema patients, with noted clinical improvements in lung function and exercise capacity.

Keyword

Emphysema; Individualized Medicine; Lung Volume Reduction; Patient Selection; Pulmonary Disease, Chronic Obstructive

MeSH Terms

Aged
Asian Continental Ancestry Group
Bronchoscopy/*methods
Forced Expiratory Volume
Humans
Lung/pathology/surgery
Male
Middle Aged
Pneumonectomy/*methods
Pulmonary Emphysema/*surgery
Severity of Illness Index
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 Forced expiratory volume in 1 sec (A) and 6-min walk distance (B) at baseline and 1 month after the procedure (Data for patient No. 3 is at 3 months because he developed a pneumothorax 2 days after the procedure and had a tube thoracostomy for 1 month). Symbols represent individual patients. Bars are median values.

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