Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
MQ Health, Macquarie University Hospital, North Ryde, New South Wales, Australia.
Respirology. 2022 Dec;27(12):1064-1072. doi: 10.1111/resp.14338. Epub 2022 Aug 2.
We have previously described reversal of collateral ventilation (CV) in a severe chronic obstructive pulmonary disease (COPD) patient with endoscopic polymer foam (EPF), prior to endoscopic lung volume reduction (ELVR) with valves. The aim of this study was to investigate the efficacy of this in a larger cohort and compare outcomes with a similar cohort with no CV.
Patients with severe COPD, with the left upper lobe (LUL) targeted for ELVR, were assessed for CV with high resolution computed tomography (HRCT). If fissure completeness was >95% they were enrolled as controls for valves alone (endobronchial valve control group [EBV-CTRL]). If fissure completeness was 80%-95%, defects were mapped to the corresponding segment, where EPF was instilled following confirmation of CV with CHARTIS. EBVs were inserted 1 month afterwards.
Fourteen patients were enrolled into both arms. After 6 months, there were significant improvements in both groups in forced expiratory volume in 1 s (FEV1; +19.7% EPF vs. +27.7% EBV-CTRL, p < 0.05); residual volume (RV; -16.2% EPF vs. -20.1% EBV-CTRL, p = NS); SGRQ (-15.1 EPF vs. -16.6 EBV-CTRL p = NS) and 6 min walk (+25.8% EPF [77.2 m] vs. +28.4% [82.3 m] EBV-CTRL p = NS). Patients with fissural defects mapped to the lingula had better outcomes than those mapped to other segments (FEV1 +22.9% vs. +16.3% p < 0.05). There were no serious adverse reactions to EPF.
EPF successfully reverses CV in severe COPD patients with a left oblique fissure that is 80%-95% complete. Following EBV, outcomes are similar to patients with complete fissures undergoing ELVR with EBV alone. EPF therapy to reverse CV potentially increases the number of COPD patients suitable for ELVR with minimal adverse reactions.
我们之前曾描述过，在接受内镜下肺减容术（ELVR）加阀治疗之前，使用内镜聚合物泡沫（EPF）可逆转严重慢性阻塞性肺疾病（COPD）患者的侧支通气（CV）。本研究旨在更大的队列中研究其疗效，并与无 CV 的类似队列进行比较。
对接受左肺上叶（LUL）ELVR 的严重 COPD 患者进行高分辨率 CT（HRCT）评估 CV。如果裂隙完整度>95%，则将其作为仅接受支气管内阀（EBV-CTRL）治疗的对照组进行入组。如果裂隙完整度为 80%-95%，则将缺陷映射到相应的节段，在确认 CV 后，使用 CHARTIS 注入 EPF。1 个月后插入 EBV。
两组均有 14 名患者入组。6 个月后，两组患者的用力呼气量（FEV1）均有显著改善（EPF 组+19.7%，EBV-CTRL 组+27.7%，p<0.05）；残气量（RV）（EPF 组-16.2%，EBV-CTRL 组-20.1%，p=NS）；圣乔治呼吸问卷（SGRQ）（EPF 组-15.1，EBV-CTRL 组-16.6，p=NS）和 6 分钟步行距离（EPF 组+25.8%[77.2m]，EBV-CTRL 组+28.4%[82.3m]，p=NS）。裂隙缺陷映射到舌段的患者比映射到其他节段的患者有更好的结果（FEV1+22.9%比+16.3%，p<0.05）。EPF 无严重不良反应。
在左斜裂隙完整度为 80%-95%的严重 COPD 患者中，EPF 可成功逆转 CV。在接受 EBV 治疗后，结果与完全裂隙接受 EBV 单独进行 ELVR 的患者相似。逆转 CV 的 EPF 治疗可能会增加适合接受 ELVR 的 COPD 患者数量，而不良反应最小。
