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Rivista sulle Malattie dell’Apparato Respiratorio
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2015 June;54(2):51-71
Bronchoscopic lung volume reduction: current evidence and future direction
Kemp S. 1, Shah P. 2
1 Sherwood Forest Hospitals, NHS Foundation Trust, Sutton‑in‑Ashfield, Nottinghamshire, UK;
2 Royal Brompton and Harefield NHS Trust, London, UK
Emphysema is a disease characterized by the destruction of lung tissue, with progressive impairment of lung function and exercise intolerance. Traditional medical therapies often provide only small improvements in symptoms, do little to improve lung function, and can have significant side effects. Even therapies with established benefits such as pulmonary rehabilitation, smoking cessation, and influenza vaccination do nothing to reverse the underlying impairments in lung function. This article reviews the evidence behind lung volume reduction surgery, discusses the development of procedures designed to improve mortality and morbidity by using semi-invasive techniques to achieve lung volume reduction, and appraises the current body of evidence for bronchoscopic lung volume reduction.
There are now a number of different methods for achieving volume reduction without recourse to surgery, with changes in lung function, exercise capacity, and quality of life demonstrated. There is, however, a conspicuous lack of both long-term and pivotal controlled trial evidence to demonstrate conclusive benefit, although a number of trials are now ongoing to address this problem, with results anticipated over the next 1 to 3 years.