Ido Firas, DiRico Michael, Lin Meng-Shan, Stahlnecker Deborah
Department of Pulmonary and Critical Care Medicine, St. Luke's University Health Network, Bethlehem, PA, USA.
J Thorac Dis. 2024 Oct 31;16(10):6820-6826. doi: 10.21037/jtd-24-717. Epub 2024 Oct 17.
Bronchoscopic lung volume reduction (BLVR) is a method of achieving lung collapse in severely emphysematous regions. One of the measures of success is the improvement in post-bronchodilator forced expiratory volume in the first second (FEV). The change in bronchodilator response (BDR) following BLVR is typically not reported, however, the changes in lung physiology that accompany endobronchial valve placement may impact aerosol drug delivery and alter the response to bronchodilators. We compared the BDR before and after BLVR to evaluate this effect.
We performed a retrospective study to analyze the change in BDR following BLVR. We included patients who underwent pulmonary function test (PFT) within 6 months of BLVR and confirmed complete lobar atelectasis. The pre-BLVR BDR for each patient served as the control, which was then compared to the post-BLVR BDR. The mean difference in the BDR before and after valve placement was determined. The comparison between pre- and post-BLVR means was performed using a -test.
A total of 35 patients were assessed for the study. Fifteen patients were excluded (due to valve removal, incomplete lobar collapse, and no pre- or post-BLVR PFT available). Of the 20 remaining patients, 14 had a positive BDR at baseline before BLVR. Following BLVR, 13 of the 14 patients demonstrated a non-significant increase in the BDR. The mean BDR for pre- and post-valve was 83.6 116.3 mL, respectively. The mean absolute increase in BDR following BLVR was 32.7 mL [95% confidence interval (CI): -32.5 to 97.8, P=0.31]. When including all 20 patients, the mean BDR pre- and post-BLVR was 47.5 86.5 mL, respectively, with a mean increase in BDR by 39 mL (95% CI: 22.3 to 100.3, P=0.21).
BLVR may improve the BDR in patients with complete lobar atelectasis.
支气管镜下肺减容术（BLVR）是一种使严重肺气肿区域肺萎陷的方法。成功的指标之一是支气管扩张剂使用后第一秒用力呼气量（FEV）的改善。然而，BLVR后支气管扩张剂反应（BDR）的变化通常未被报道，但是，支气管内瓣膜置入伴随的肺生理变化可能会影响气雾剂药物递送并改变对支气管扩张剂的反应。我们比较了BLVR前后的BDR以评估这种影响。
我们进行了一项回顾性研究，以分析BLVR后BDR的变化。我们纳入了在BLVR后6个月内接受肺功能测试（PFT）并确认完全肺叶萎陷的患者。每位患者BLVR前的BDR作为对照，然后与BLVR后的BDR进行比较。确定瓣膜置入前后BDR的平均差异。使用t检验进行BLVR前后均值的比较。
共有35例患者接受了该研究评估。15例患者被排除（由于瓣膜移除、肺叶塌陷不完全以及无BLVR前后的PFT数据）。在其余20例患者中，14例在BLVR前基线时BDR为阳性。BLVR后，14例患者中的13例BDR有不显著增加。瓣膜置入前后的平均BDR分别为83.6±116.3 mL。BLVR后BDR的平均绝对增加量为32.7 mL [95%置信区间（CI）：-32.5至97.8，P = 0.31]。当纳入所有20例患者时，BLVR前后的平均BDR分别为47.5±86.5 mL，BDR平均增加39 mL（95% CI：22.3至100.3，P = 0.21）。
BLVR可能改善完全肺叶萎陷患者的BDR。
