Abstract
Emphysema and asthma are responsible for economic and social burden. Altering the
natural course of these diseases is a field of intense research. The National Emphysema
Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly
reduce both morbidity and mortality in properly selected patients. LVRS is seldom
performed, however, due to the high morbidity associated with the surgery. Numerous
bronchoscopic interventions have been introduced with the goal of providing the clinical
benefits of LVRS without the surgical complications. Thus far, these modalities have
not produced the results once hoped. However, through active modification of both
technique and patient selection, the role of minimally invasive modalities in the
treatment of emphysema continues to evolve. Bronchial thermoplasty (BT) is a method
of delivering controlled heat to airway mucosa with the goal of reducing airway smooth
muscle mass and hence bronchoconstriction. In patients suffering from asthma who cannot
achieve control with standard medical care, BT has been shown to be safe and improves
symptoms, with long lasting benefit. BT does not seem to affect traditional markers
of asthma severity such as forced expiratory volume in 1 second and questions remain
regarding proper patient selection for this therapy and its true physiologic effects.
This article is a review of bronchoscopic modalities for emphysema and asthma.
Keywords
emphysema - asthma - lung volume reduction - endobronchial valve - bronchial thermoplasty
