Abstract
Background Endoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusion capacity of the lung for carbon monoxide (DLCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to DLCO for patients treated with ELVR.
Methods We assessed DLCO at baseline and 3-months follow-up and compared pre- and postprocedural pulmonary function test (PFT), quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.
Results 121 patients treated with ELVR were analysed. 34 patients with a DLCO ≤20% and 87 patients with a DLCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV1) improved significantly only in patients with a DLCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (DLCO ≤20%: 17.6% versus DLCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.
Conclusions ELVR improves lung function as well as quality of life in patients with DLCO >20% and DLCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low DLCO.
Footnotes
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Conflict of interest: Dr. Lenga has nothing to disclose.
Conflict of interest: Dr. Ruwwe-Glösenkamp has nothing do disclose
Conflict of interest: Dr. Grah has nothing to disclose.
Conflict of interest: Dr. Pfannschmidt has nothing to disclose.
Conflict of interest: Prof. Rückert has nothing to disclose.
Conflict of interest: Dr. Eggeling has nothing to disclose.
Conflict of interest: Dr. Schmidt has nothing to disclose.
Conflict of interest: Dr. Schneider has nothing to disclose.
Conflict of interest: Dr. Sven has nothing to disclose.Dr. Kurz has nothing to disclose.
Conflict of interest: Dr. Leschber has nothing to disclose.
Conflict of interest: Dr. Gebhardt has nothing to disclose.
Conflict of interest: Dr. Schega has nothing to disclose.
Conflict of interest: Dr. Borchardt has nothing to disclose.
Conflict of interest: Dr. Hübner reports personal fees and non-financial support from Pulmonx, from null, from null, from null, from null, from null, from null, from null, outside the submitted work; .Dr. Hübner reports personal fees and non-financial support from Pulmonx, outside the submitted work.
Conflict of interest: Dr. Birgit has nothing to disclose.
Conflict of interest: Dr. Glaeser reports personal fees from Boehringer Ingelheim, grants and personal fees from Novartis Pharma, personal fees from Roche Pharma, personal fees from Berlin Chemie, personal fees from PneumRx, personal fees from PulmonX, personal fees from Actelion Pharma, personal fees from Bayer Healthcare, outside the submitted work.
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- Received June 30, 2020.
- Accepted September 23, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
