TY - JOUR T1 - Lung volume reduction in emphysema: a pragmatic prospective cohort study JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00877-2020 VL - 7 IS - 2 SP - 00877-2020 AU - Christophe Dooms AU - Astrid Blondeel AU - Laurens J. Ceulemans AU - Johan Coolen AU - Stephanie Everaerts AU - Heleen Demeyer AU - Thierry Troosters AU - Geert Verleden AU - Dirk Van Raemdonck AU - Wim Janssens Y1 - 2021/04/01 UR - http://openres.ersjournals.com/content/7/2/00877-2020.abstract N2 - 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 monocentre cohort study evaluated ELVR versus no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a forced expiratory volume in 1 s (FEV1) improvement of ⩾100 mL at 3-month follow-up. Changes in FEV1, residual volume (RV), 6-min walk distance (6MWD) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were evaluated at 6-month follow-up. 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 months’ follow-up, eligible patients were referred for LVRS (n=16) with another 6-month follow-up. At 3-month follow-up, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV1 improvement of ⩾100 mL. Between-group differences (mean±sem) for ELVR versus no-ELVR at 6-month follow-up were FEV1 +0.21±0.05 L; RV −0.95±0.21 L; 6MWD 58±17 m and SGRQ −18±5 points. At 6-month follow-up, 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.This pragmatic, real-life clinical algorithm evaluates an approach with endoscopic lung volume reduction as a less invasive first option and lung volume reduction surgery as a powerful alternative in advanced heterogeneous emphysema https://bit.ly/39gckqc ER -