Endobronchial Coils Versus Lung Volume Reduction Surgery or Medical Therapy for Treatment of Advanced Homogenous Emphysema.

Rationale : Bronchoscopic lung volume reduction utilizing shape-memory nitinol endobronchial coils (EBC) may be safer and more effective in severely hyperinflated homogeneous emphysema compared to medical therapy or lung volume reduction surgery (LVRS). Methods : The effect of bilateral EBC in patients with homogeneous emphysema on spirometry, lung volumes and survival was compared to patients with homogeneous emphysema randomized in the National Emphysema Treatment Trial (NETT) to LVRS or medical therapy. NETT participants were selected to match EBC participants in age, baseline spirometry, and gender. Outcomes were compared from baseline, at 6 and 12 months. Results : There were no significant baseline differences in gender in the EBC, NETT-LVRS or medical treatment patients. At baseline no differences existed between EBC and NETT-LVRS patients in forced expiratory volume in 1 second ( FEV ₁ ) or total lung capacity (TLC) %-predicted; residual volume (RV) and diffusing capacity of the lung for carbon monoxide (DLco) %-predicted were higher in the EBC group compared to NETT-LVRS ( p < 0.001). Compared to the medical treatment group, EBC produced greater improvements in FEV ₁ and RV but not TLC at 6 months. FEV ₁ and RV in the EBC group remained significantly improved at 12-months compared to the medical treatment group. While all 3 therapies improved quality of life, survival at 12 months with EBC or medical therapy was greater than NETT-LVRS. Conclusion : EBC may be a potential therapeutic option in patients with severe homogeneous emphysema and hyperinflation who are already receiving optimal medical treatment.
Competing Interests: Authors NM, TK, DC, CD, SB, MP, FS, CW, SL and JH have nothing to disclose. FJH reports personal fees from Pulmonx, Uptake, BTG, and Olympus outside the submitted work. PLS reports personal fees from Broncus, Creo Medical, Holairia, Olympus, Medtronic and PneumRX/BTG as consultant on a scientific advisory board and also reports other support: a sponsorship to Imperial College for a bronchoscopy course by from ERBE, Cook medical, Medtronic, Boston Scientific, Aquilant, Broncus, Pulmonx, Olympus, & PneumRX outside the submitted work. DS reports grants, personal fees, non-financial support and other from PneumRx/BTG; grants, personal fees, non-financial support and other from Holaira, Inc; grants, personal fees, non-financial support and other from CSA Medical; and grants, personal fees, non-financial support and other from PulmonX Inc., outside the submitted work. SHB reports support from PneumRx during the conduct of the study. GD reports personal fees from BTG/pneumRx during the conduct of the study. MH reports personal fees from BTG during the conduct of the study. RK reports grants from Pulmonx, PneumoRx, and Boston Scientific during the conduct of the study. FCS reports grants and personal fees from PneumRx, and grants from PulmonX and Spiration outside the submitted work. GJC reports grants from Boehringer- Ingelheim, Novartis Astra Zeneca, Respironics, MedImmune, Actelion, Forest, Pearl Ikaria, Aeris, PneumRx, and Pulmonx and other support from HGE Health Care Solutions, Inc, Amirall, Boehringer- Ingelheim, and Holaira, outside the submitted work.