Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema

Jorine E. Hartman*, Karin Klooster, Sonja W. S. Augustijn, Wouter H. van Geffen, Justin L. Garner, Pallav L. Shah, Nick H. T. Ten Hacken, Dirk-Jan Slebos

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
22 Downloads (Pure)

Abstract

BACKGROUND: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown.

OBJECTIVES: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment.

METHODS: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment.

RESULTS: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level.

CONCLUSIONS: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.

Original languageEnglish
Pages (from-to)443-451
Number of pages9
JournalRespiration
Volume100
Issue number5
Early online date19-Mar-2021
DOIs
Publication statusPublished - May-2021

Keywords

  • Female
  • Humans
  • Lung/physiopathology
  • Male
  • Middle Aged
  • Pneumonectomy/adverse effects
  • Prospective Studies
  • Pulmonary Emphysema/physiopathology
  • Residual Volume
  • Respiratory Function Tests
  • Treatment Outcome

Cite this