Abstract
Severe emphysema with hyperinflation presents a therapeutic challenge. Inhaled medication
has limited efficacy in individuals with mechanical constraints to the respiratory
pump and impaired gas exchange. Lung volume reduction surgery (LVRS) reestablishes
some semblance of normal physiology, resecting grossly expanded severely diseased
tissue to restore the function of compromised relatively healthy lung, and has been
shown to significantly improve exercise capacity, quality of life, and survival, especially
in individuals with upper-lobe predominant emphysema and low-baseline exercise capacity,
albeit with higher early morbidity and mortality. Bronchoscopic lung volume reduction
achieved by deflating nonfunctioning parts of the lung is promoted as a less invasive
and safer approach. Endobronchial valve implantation has demonstrated comparable outcomes
to LVRS in selected individuals and has recently received approvals by the National
Institute of Clinical Excellence in the United Kingdom and the Food and Drug Administration
in the United States of America. Endobronchial coils are proving a viable treatment
option in severe hyperinflation in the presence of collateral ventilation in selected
cases of homogeneous disease. Modalities including vapor and sealant are delivered
using a segmental strategy preserving healthier tissue within the same target lobe-efficacy
and safety-data are, however, limited. This article will review the data supporting
these novel technologies.
Keywords
chronic obstructive pulmonary disease - lung volume reduction - pulmonary emphysema
