University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands,
University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
Respiration. 2020;99(2):163-170. doi: 10.1159/000505428. Epub 2020 Jan 21.
For selected patients with severe emphysema, bronchoscopic lung volume reduction with endobronchial valves (EBV) is recognized as an additional treatment option. In most trials investigating EBV treatment, patients with a very low diffusing capacity (DLCO) were excluded from participation.
Our goal was to investigate whether EBV treatment in patients with emphysema with a very low DLCO is safe and effective.
This was a single-center retrospective analysis including patients with emphysema and a DLCO ≤20%pred who underwent EBV treatment. Follow-up was performed 6 months post-treatment. Outcome parameters were compared to a historical matched control group (DLCO >20%pred, matched for sex, age, forced expiratory volume in 1 s [FEV1], and residual volume [RV]).
Twenty patients (80% female, 64 ± 6 years, FEV1 26 ± 6%pred, RV 233 ± 45%pred, DLCO 18 ± 1.6%pred) underwent EBV treatment. At 6 months follow-up, we found a statistically significant improvement in FEV1 (0.08 ± 0.12 L), RV (-0.45 ± 0.95 L), 6-min walking distance (38 ± 65 m), and St. George's Respiratory Questionnaire (-12 ± 13 points). With the exception of FEV1, all exceeded the minimal clinically important difference. The most common serious adverse event was a pneumothorax requiring intervention (15%). There were no significant differences in outcome compared to the DLCO >20%pred control group.
In this single-center retrospective analysis, we showed statistically significant and clinically relevant improvements in lung function, exercise capacity, and quality of life up to 6 months after EBV treatment in emphysema patients with a DLCO ≤20% (14-20%) of predicted with no increased risk of serious adverse events.
对于某些严重肺气肿患者，支气管镜下肺减容术（endobronchial valves，EBV）被认为是一种额外的治疗选择。在大多数研究 EBV 治疗的试验中，弥散量（diffusing capacity，DLCO）非常低的患者被排除在试验之外。
我们旨在研究在 DLCO 非常低的肺气肿患者中，EBV 治疗是否安全有效。
这是一项单中心回顾性分析，纳入了 DLCO ≤20%预测值的肺气肿患者，这些患者接受了 EBV 治疗。治疗后 6 个月进行随访。将结果参数与历史匹配的对照组（DLCO >20%预测值，性别、年龄、1 秒用力呼气容积（forced expiratory volume in 1 s，FEV1）和残气量（residual volume，RV）相匹配）进行比较。
共 20 例患者（80%女性，64 ± 6 岁，FEV1 26 ± 6%预测值，RV 233 ± 45%预测值，DLCO 18 ± 1.6%预测值）接受了 EBV 治疗。在 6 个月随访时，我们发现 FEV1（0.08 ± 0.12 L）、RV（-0.45 ± 0.95 L）、6 分钟步行距离（38 ± 65 m）和圣乔治呼吸问卷（St. George's Respiratory Questionnaire，SGRQ）（-12 ± 13 分）均有统计学显著改善。除了 FEV1 外，所有指标的改善均超过了最小临床重要差异。最常见的严重不良事件是需要干预的气胸（15%）。与 DLCO >20%预测值的对照组相比，结果没有显著差异。
在这项单中心回顾性分析中，我们显示在 DLCO ≤20%（14-20%）预测值的肺气肿患者中，EBV 治疗后 6 个月，肺功能、运动能力和生活质量均有统计学显著和临床相关的改善，且严重不良事件的风险没有增加。
