Endoscopic lung volume reduction with endobronchial valves in very low D LCO patients: results from the German Registry - Lungenemphysemregister e.V

Pavlina Lenga; Christoph Ruwwe-Glösenkamp; Christian Grah; Joachim Pfannschmidt; Jens Rückert; Stephan Eggeling; Sven Gläser; Bernd Schmidt; Paul Schneider; Sylke Kurz; Gunda Leschber; Andreas Gebhardt; Birgit Becke; Olaf Schega; Jakob Borchardt; Ralf-Harto Hübner

doi:10.1183/23120541.00449-2020

Endoscopic lung volume reduction with endobronchial valves in very low D _LCO patients: results from the German Registry - Lungenemphysemregister e.V

ERJ Open Res. 2021 Jan 25;7(1):00449-2020. doi: 10.1183/23120541.00449-2020. eCollection 2021 Jan.

Authors

Pavlina Lenga^{1

2}, Christoph Ruwwe-Glösenkamp^{1

2}, Christian Grah³, Joachim Pfannschmidt⁴, Jens Rückert⁵, Stephan Eggeling⁶, Sven Gläser⁷, Bernd Schmidt⁸, Paul Schneider⁹, Sylke Kurz¹⁰, Gunda Leschber¹¹, Andreas Gebhardt¹², Birgit Becke¹³, Olaf Schega¹⁴, Jakob Borchardt¹⁵, Ralf-Harto Hübner¹

Affiliations

¹ Dept of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
² These authors contributed equally.
³ Dept of Internal Medicine and Respiratory Medicine, Clinic Havelhöhe Berlin, Berlin, Germany.
⁴ Dept of Thoracic Surgery, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, Berlin, Germany.
⁵ Dept of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁶ Dept of Thoracic Surgery, Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Berlin, Germany.
⁷ Dept of Pulmonary Medicine and Infectious Diseases, Vivantes-Klinikum Neukölln, Berlin, Germany.
⁸ Dept of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany.
⁹ Dept of Thoracic Surgery, DRK Kliniken Berlin Mitte, Berlin, Germany.
¹⁰ Dept of Respiratory Medicine, ELK Berlin Chest Hospital, Berlin, Germany.
¹¹ Dept of Thoracic Surgery, ELK Berlin Chest Hospital, Berlin, Germany.
¹² Dept of Internal Medicine and Respiratory Medicine, Helios Hospital Emil von Behring, Berlin, Germany.
¹³ Dept of Respiratory Medicine, Johanniter-Krankenhaus, Treuenbrietzen, Germany.
¹⁴ Dept of Thoracic Surgery, Johanniter-Krankenhaus, Treuenbrietzen, Germany.
¹⁵ Dept of Pulmonary Medicine and Infectious Diseases, Vivantes-Klinikum Friedrichshain, Berlin, Germany.

Abstract

Background: Endoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusing capacity of the lung for carbon monoxide (D _LCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to D _LCO for patients treated with ELVR.

Methods: We assessed D _LCO at baseline and 3 months follow-up and compared pre- and postprocedural pulmonary function test, quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.

Results: In total, 121 patients treated with ELVR were analysed. Thirty-four patients with a D _LCO ≤20% and 87 patients with a D _LCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups, and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV₁) improved significantly only in patients with a D _LCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (D _LCO ≤20%: 17.6% versus D _LCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.

Conclusions: ELVR improves lung function as well as quality of life in patients with D _LCO >20% and D _LCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low D _LCO.