Endobronchial valves for emphysema and persistent air-leak: 10-year experience in an Asian country

Jin-Young Huh; Byeong-Ho Jeong; Ho Il Yoon; Hojoong Kim; Young-Jae Cho; Changhwan Kim; Seung Jun Lee; Hwan Hee Kim; Seung Won Ra; Ye Jin Lee; Beong Ki Kim; Sung Kyoung Kim; Ki Hyun Seo; Sei Won Lee

doi:10.1186/s12890-024-02982-2

Endobronchial valves for emphysema and persistent air-leak: 10-year experience in an Asian country

BMC Pulm Med. 2024 Apr 3;24(1):162. doi: 10.1186/s12890-024-02982-2.

Authors

Jin-Young Huh¹, Byeong-Ho Jeong², Ho Il Yoon³, Hojoong Kim², Young-Jae Cho³, Changhwan Kim^{4

5}, Seung Jun Lee⁶, Hwan Hee Kim⁷, Seung Won Ra⁸, Ye Jin Lee³, Beong Ki Kim⁹, Sung Kyoung Kim¹⁰, Ki Hyun Seo¹¹, Sei Won Lee¹²

Affiliations

¹ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁴ Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
⁵ Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea.
⁶ Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea.
⁷ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁸ Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
⁹ Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea.
¹⁰ Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea.
¹² Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea. seiwon@amc.seoul.kr.

Abstract

Background: Endobronchial valve (EBV) therapy, a validated method for bronchoscopic lung volume reduction (BLVR) in severe emphysema, has been explored for persistent air-leak (PAL) management. However, its effectiveness and safety in the Asian population require further real-world evaluation. In this study, we assessed the outcomes of treatment with EBV within this demographic.

Methods: We conducted a retrospective analysis of medical records from 11 Korean centers. For the emphysema cohort, inclusion criteria were patients diagnosed with emphysema who underwent bronchoscopy intended for BLVR. We assessed these patients for clinical outcomes of chronic obstructive pulmonary disease. All patients with PAL who underwent treatment with EBV were included. We identified the underlying causes of PAL and evaluated clinical outcomes after the procedure.

Results: The severe emphysema cohort comprised 192 patients with an average age of 70.3 years, and 95.8% of them were men. Ultimately, 137 underwent treatment with EBV. Three months after the procedure, the BLVR group demonstrated a significant improvement in forced expiratory volume in 1 s (+160 mL vs. +30 mL; P = 0.009). Radiographic evidence of lung volume reduction 6 months after BLVR was significantly associated with improved survival (adjusted hazard ratio 0.020; 95% confidence interval 0.038-0.650; P = 0.010). Although pneumothorax was more common in the BLVR group (18.9% vs. 3.8%; P = 0.018), death was higher in the no-BLVR group (38.5% vs. 54.5%, P = 0.001), whereas other adverse events were comparable between the groups. Within the subset of 18 patients with PAL, the predominant causes of air-leak included spontaneous secondary pneumothorax (44.0%), parapneumonic effusion/empyema (22.2%), and post-lung resection surgery (16.7%). Following the treatment, the majority (77.8%) successfully had their chest tubes removed. Post-procedural complications were minimal, with two incidences of hemoptysis and one of empyema, all of which were effectively managed.

Conclusions: Treatment with EBV provides substantial clinical benefits in the management of emphysema and PAL in the Asian population, suggesting a favorable outcome for this therapeutic approach.

Keywords: Bronchoscopies; Chronic obstructive pulmonary disease; Emphysema; Pneumothorax.

MeSH terms

Aged
Bronchoscopy / methods
Emphysema*
Empyema* / etiology
Empyema* / surgery
Female
Forced Expiratory Volume
Humans
Male
Pneumonectomy / adverse effects
Pneumothorax* / etiology
Pneumothorax* / surgery
Pulmonary Emphysema*
Retrospective Studies
Treatment Outcome

Grants and funding

This was investigator-initiated research, and the sponsor has no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript./Pulmonx Corporation, Redwood City, CA, USA