An update on endobronchial valve therapy for severe emphysema: real world data and special indications

INTRODUCTION: Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBV) is a guideline therapy for patients with severe emphysema without interlobar collateral ventilation, based on solid results from multiple randomized clinical trials (RCTs). However, whether its efficacy and safety in real-world clinical settings are comparable to those observed in RCTs has not been fully investigated. Additionally, recent reports on EBV therapy have focused on specialized populations (e.g. very low FEV 1, very low D LCO) that were not represented in the RCTs.

AREAS COVERED: We have summarized the efficacy and safety of the publications on BLVR with EBVs in real-world settings and in specialized populations, and have discussed these findings in relation to the RCTs data.

EXPERT OPINION: The benefits of BLVR with EBVs have effectively translated into real-world clinical practice with a tolerable safety profile. These benefits and acceptable safety profile were also observed in specialized populations not fully represented in RCTs. We believe it is crucial to establish a nationwide registry in each country to keep track of outcome for quality and consistency, and to have a multidisciplinary COPD team discussion in each treating institution to keep on ensuring the successful clinical practice of BLVR with EBVs.