The study compares two different procedures for lung volume reduction in people with emphysema

The study compares two different procedures for lung volume reduction in people with emphysema

The first randomized controlled trial to compare two different lung volume reduction procedures in people with emphysema has found that both result in similar improvements in lung function, shortness of breath and physical performance.

The results of the study of lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BVLR), presented today (Tuesday) at the International Congress of the European Respiratory Society in Barcelona, ​​Spain, should help doctors and patients choose the best approach to treat emphysema.

Emphysema is a chronic lung disease that is usually caused by smoking. The walls of the air sacs (alveoli) in the lungs weaken and dissolve, leaving abnormally large air spaces that remain filled with air even when the patient exhales. Symptoms include shortness of breath, cough, fatigue and weight loss. In people with unevenly distributed lung damage, treatment that targets the worst area of ​​emphysema by reducing lung volume by about 20-30% can improve airflow and gas exchange in the alveoli in the remaining parts of the lung.

LVRS involves keyhole surgery into the chest to access the lungs and remove the areas of the lungs most affected by emphysema. In BVLR, the procedure is performed using a fiber-optic camera that is inserted into the lungs through the mouth or nose. One-way valves (endobronchial valves) are inserted into the airways leading to the target lung lobe, emptying it almost completely.

Ms Sara Buttery, research physiotherapist and PhD candidate at the National Heart and Lung Institute, Imperial College London (UK), told the Congress: "Both procedures have been shown to have positive outcomes in terms of lung function, shortness of breath, physical performance and quality of life. To date there has been no direct comparison of the two to inform decision-making as to when a person appears suitable for both. Bronchoscopic lung volume reduction is a less invasive option and is considered 'less risky', but to date there has been no significant research to support this."

In the CELEB trial, Ms. Buttery and colleagues randomized 88 patients with a median age of 64 years to receive either LVRS (41 patients) or BLVR (47 patients) and followed them for a year to study outcomes. They measured patients' response to treatment using the iBODE score. This score includes four commonly used measures: body mass index, airflow obstruction, shortness of breath (dyspnea), and physical performance. They also examined the change in residual volume (RV%), which provides a measure of the amount of "gas traps" where excess air remains in the patient's lungs even after complete exhalation.

Both groups improved to a similar extent one year after treatment. Surgery and valve treatment resulted in similar reductions in gas entrapment and similar improvements in both the overall iBODE score and each of the individual measures that compose it. Both treatments also appeared to be equally safe, with only one death in each arm of the study after one year, despite being in a population with severe lung disease.

The results of this study will be important for clinicians and patients to guide decision-making about which treatment option to choose if a person is suitable for either approach and provide more evidence on expected outcomes and risks.

Ms Sara Buttery, research physiotherapist and PhD candidate at the National Heart and Lung Institute, Imperial College London

Information from computed tomography (CT) scans, the person's general health, whether or not they have other significant medical conditions and whether they have frequent flare-ups of their condition, as well as individual preferences all contribute to deciding whether a lung volume reduction procedure is best for them and which approach might be preferred. Results may vary between patients after either procedure, but they should be able to do more with fewer symptoms.

"For example, they might be able to play with grandchildren, walk up a flight of stairs without having to sit down to recover, or be able to walk a mile without having to stop. We often say that to people considering these treatments, they could expect to set the clocks back two or three years to what their symptoms were at that time," she said.

Ms Buttery said that while this study refuted the hypothesis that surgery was significantly more effective than valve treatment, further research was needed in larger studies to see if people could be identified who respond particularly well to one approach or the other. The cost advantage of the two procedures should also be examined.

Dr. Alexander Mathioudakis is an NIHR Clinical Lecturer in Respiratory Medicine at the University of Manchester and Secretary of the ERS Airway Pharmacology and Treatment Group and was not involved in the research. He said: "The results of this first randomized controlled trial suggest that BVLR could be a good therapeutic option for those patients for whom both procedures are suitable. Lung volume reduction surgery is an invasive operation as it requires a small incision in the chest, which is stitched after the procedure. As such, it carries risks associated with surgery and it takes longer to recover from it than bronchoscopic lung volume reduction. On the other hand, the placement of endobronchial valves is also fraught with side effects such as pneumonia, or valve displacement. Therefore, both the safety and effectiveness of the two procedures need to be further investigated in larger patient groups, but the results of this study are very encouraging.”

Source:

European Respiratory Society (ERS)

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