Efficacy of bronchoscopic lung volume reduction: A meta-analysis

• Type of Material: Article
• Authors: Imran Iftikhar, Emory University; Franklin R McGuire, University of South Carolina; Ali I Musani, National Jewish Health
• Language: English
• Date: 2014-05-14
• Publisher: Dove Medical Press
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Iftikhar et al. This work is published by Dove Medical Press Limited.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2147/COPD.S63378
• Title of Journal or Parent Work: International Journal of Chronic Obstructive Pulmonary Disease
• ISSN: 1176-9106
• Volume: 9
• Start Page: 481
• End Page: 491
• Keywords: emphysema; Exercise Therapy; Exercise Tolerance; Walking; stents; sealants; endobronchial valves; Humans; Lung; coils; Recovery of Function; Pulmonary Emphysema; Stents; Time Factors; Lung Volume Measurements; Surveys and Questionnaires; Forced Expiratory Volume; Pneumonectomy; Treatment Outcome; Bronchoscopy; Pulmonary Disease, Chronic Obstructive
• Research Categories: Health Sciences, General; Health Sciences, Health Care Management

Abstract

Background: Over the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR) surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR) in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods. Methods: Eligible studies were retrieved from PubMed and Embase for the following BLVR methods: one-way valves, sealants (BioLVR), LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George's Respiratory Questionnaire. Secondary outcomes included treatment-related complications. Results: Except for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second) was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001); in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01); and in St George's Respiratory Questionnaire was -8.88 points (95% CI: -12.12 to -5.64; P<0.001). Conclusion: The preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninferiority, if not equivalence, when compared to what is known for surgical LVR.