REVIEW  COMPETENCE IN INTERVENTIONAL PULMONOLOGY Free access

Panminerva Medica 2019 September;61(3):401-21

DOI: 10.23736/S0031-0808.18.03571-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Competence in bronchoscopic treatments in emphysema

Michela BEZZI ¹, Valentina LUZZI ² ✉, Mauro NOVALI ¹, Andrea COMEL ³, Guido POLESE ⁴, Lorenzo CORBETTA ⁵

¹ Spedali Civili di Brescia, Brescia, Italy; ² Department of Interventional Pneumology, Careggi University Hospital, Florence, Italy; ³ Operative Unit of Pneumology, Department of Medicine, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy; ⁴ Operative Unit of Pneumology, Hospital of Villafranca, Villafranca di Verona Centro Polivalente (CUBO), Villafranca di Verona, Verona, Italy; ⁵ Unit of Interventional Pneumology, University of Florence, Florence, Italy

Bronchoscopic lung volume reduction (BLVR) has been proven to be effective in patients with severe emphysema. These techniques are divided into two groups: non-blocking devices that are independent of collateral ventilation and blocking devices that are dependent on collateral ventilation so the choice of the target lobe with inadequate scissors is crucial for the success of the treatment. Current evidences suggest that not all classes and phenotypes of emphysema will benefit from BLVR, and that each technique appears to provide a greater benefit to specific sub-groups of patients. Careful patient selection is imperative to prevent insertion in patients unlikely to gain clinical benefits as well as wasteful expenditure. The Chartis system represents the gold standard for measuring fissure integrity and is a direct measurement method. Indirect method is instead the TC study which, thanks to the development of software for quantitative analysis, allows us to obtain reliable measurements of regional density of parenchyma, airway thickness and scissor integrity. BLVR is a highly complex procedure: a first-level competence is a pre-requisite for admission to training. The practical training must be based on discussion of clinical cases and the insertion techniques of the different devices on plastic or animal models, or on cadavers. A specific course, offering final certification, has been developed on the use of Zephyr valves.

KEY WORDS: Bronchoscopy - Pulmonary emphysema - Pulmonary disease, chronic obstructive