Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Respiration. 2021;100(5):443-451. doi: 10.1159/000514319. Epub 2021 Mar 19.
So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown.
The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment.
This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment.
Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level.
Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
到目前为止，已有 3 项随机对照试验表明，支气管内使用线圈进行治疗是安全有效的。然而，其确切的治疗基础机制和最佳反应预测因子尚不清楚。
本研究旨在进一步了解肺减容线圈治疗的基础生理学机制，并确定对该治疗有反应的潜在预测因子。
这是一项前瞻性非随机单中心研究，纳入了双侧接受线圈治疗的患者。患者在基线和治疗后 3 个月时接受了大量的物理测试。
共纳入 24 例患者（29%为男性，平均年龄 62 岁，第 1 秒用力呼气量[FEV1]为预计值的 26%，残气量[RV]为预计值的 231%）。治疗 3 个月后，患者的肺功能、静态过度充气、气道阻力、空气潴留、经 CT 扫描测量的治疗肺叶 RV 和治疗肺叶空气潴留、运动能力和生活质量均有显著改善。RV 和气道阻力的变化与 FEV1、用力肺活量、空气潴留、最大呼气压力、动态顺应性和动态过度充气的变化显著相关。基线时的治疗反应预测因子包括较高的 RV、较大的空气潴留、治疗肺叶的肺气肿评分较高以及较低的体力活动水平。
我们的结果证实了肺气肿患者从支气管内线圈治疗中获益。主要作用机制是降低静态过度充气，改善气道阻力，进而改变动态肺力学。然而，需要选择合适的患者人群进行治疗才能获益，这些患者应包括有严重肺过度充气、严重空气潴留和目标肺叶有明显肺气肿的患者。
