RT Journal Article SR Electronic T1 Lung volume reduction in emphysema: a pragmatic prospective cohort study JF ERJ Open Research JO erjor FD European Respiratory Society SP 00877-2020 DO 10.1183/23120541.00877-2020 A1 Christophe Dooms A1 Astrid Blondeel A1 Laurens Ceulemans A1 Johan Coolen A1 Stephanie Everaerts A1 Heleen Demeyer A1 Thierry Troosters A1 Geert Verleden A1 Dirk Van Raemdonck A1 Wim Janssens YR 2021 UL http://openres.ersjournals.com/content/early/2021/03/26/23120541.00877-2020.abstract AB Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema.This prospective monocenter cohort study evaluated ELVR versus no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a FEV1 improvement of 100 mL or greater at 3 months follow-up (3 m FU). Changes in FEV1, residual volume (RV), 6-minute-walk distance (6 MWD), and quality of life (SGRQ) were evaluated at 6 months follow-up (6 m FU). Hospital stay and treatment-related serious adverse events were monitored.From 106 subjects screened, 38 subjects were enrolled comparing ELVR (n=20) with no-ELVR (n=18). After 6 m FU, eligible patients were referred for LVRS (n=16) with another 6 m FU. At 3 m FU, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV1 improvement of 100 mL or more. Between-group differences (mean±sem) for ELVR versus no-ELVR at 6 m FU was FEV1 +0.21±0.05 L; RV −0.95±0.21 L; 6MWD 58±17 m and SGRQ −18±5 points. At 6 m FU, within-group differences (mean±sem) for LVRS showed FEV1 +0.27±0.06 L; RV −1.49±0.22 L and 6MWD +75±18 m. Serious adverse events in 81% versus 45% of subjects (p=0.04) and a median hospital stay of 15 versus 5 days (p<0.001) were observed for LVRS versus ELVR, respectively.This pragmatic prospective cohort study supports a clinical approach with ELVR as a less invasive first option and LVRS as powerful alternative in severe heterogeneous emphysema.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Dooms has nothing to disclose.Conflict of interest: Dr. Blondeel has nothing to disclose.Conflict of interest: Dr. Ceulemans has nothing to disclose.Conflict of interest: Dr. Coolen has nothing to disclose.Conflict of interest: Dr. Everaerts has nothing to disclose.Conflict of interest: Dr. Demeyer has nothing to disclose.Conflict of interest: Dr. Troosters has nothing to disclose.Conflict of interest: Dr. Verleden has nothing to disclose.Conflict of interest: Dr. Van Raemdonck has nothing to disclose.Conflict of interest: Dr. Janssens reports grants from PulmonX (for the endobronchial valves). He receives grants from AstraZeneca and Chiesi, outside the submitted work; Wim Janssens is co-founder of ArtiQ, a KU Leuven spin-off company in respiratory diseases.