Bronchoscopic lung volume reduction in patients with severe homogeneous lung emphysema: a pilot study

Background and objective: After bronchoscopic lung-volume reduction (LVR) improvement in pulmonary function and exercising tolerance can be achieved in patients with severe heterogeneous lung emphysema. Feasibility and safety for one-way valve placement in homogeneous emphysema were evaluated. Patients and methods: Ten patients entered this prospective study. In all cases a homogeneous distribution was confirmed by computer analysis of the CT-scans. We performed unilateral LVR and occluded the lobe with the lowest perfusion, measured by nuclear scintigraphy. Endpoints of the study were changes in lung function test, quality of life and 6-minutes-walk-test (6-MWT) at day 30 and 90 and the safety of the procedure. Results: Preoperative mean forced expiratory volume in I second (FEV1) was 0.931 (range 0.55-1.351), mean residual volume was 5.231(3.55-8.241) and 6-MWT was 325 m (150-480 m). Improvement of dyspnoe and exercising tolerance was reported in 7 cases. No major changes in lung function were evident at days 30 and 90. A trend towards improvement was observed in 6-MWT (Delta MW + 10.4 +/- 9.8%). One pneumothorax was noticed, in one case the valves were removed after 90 days because of recurrent infections. Conclusions: This study shows that bronchoscopic LVR in patients with severe homogeneous emphysema is feasible and seems to be safe. In contrast to surgical LVR patients may have a cinical benefit by bronchoscopic treatment. Longtime follow-up and patient selection criteria have to be examined in larger trials.