Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report

초록

Purpose: Endobronchial valve (EBV) therapy is increasingly being seen as a therapeutic option for advanced emphysema, but its clinical utility in Asian populations, who may have different phenotypes to other ethnic populations, has not been assessed. Patients and methods: This prospective open-label single-arm clinical trial examined the clinical efficacy and the safety of EBV in 43 consecutive patients (mean age 68.4 +/- 7.5, forced expiratory volume in 1 second [FEV1]24.5%+/- 10.7% predicted, residual volume 208.7%+/- 47.9% predicted) with severe emphysema with complete fissure and no collateral ventilation in a tertiary referral hospital in Korea. Results: Compared to baseline, the patients exhibited significant improvements 6 months after EBV therapy in terms of FEV1 (from 0.68 +/- 0.26 L to 0.92 +/- 0.40 L; P<0.001), 6-minute walk distance (from 233.5 +/- 114.8 m to 299.6 +/- 87.5 m; P=0.012), modified Medical Research Council dyspnea scale (from 3.7 +/- 0.6 to 2.4 +/- 1.2; P<0.001), and St George's Respiratory Questionnaire (from 65.59 +/- 13.07 to 53.76 +/- 11.40; P=0.028). Nine patients (20.9%) had a tuberculosis scar, but these scars did not affect target lobe volume reduction or pneumothorax frequency. Thirteen patients had adverse events, ten (23.3%) developed pneumothorax, which included one death due to tension pneumothorax. Conclusion: EBV therapy was as effective and safe in Korean patients as it has been shown to be in Western countries.

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