Efficacy of bronchoscopic lung volume reduction: A meta-analysis

• Authors: Imran Iftikhar, Emory University; Franklin R McGuire, University of South Carolina; Ali I Musani, National Jewish Health
• Journal Title: International Journal of Chronic Obstructive Pulmonary Disease
• Volume: Volume 9
• Publisher: Dove Medical Press | 2014-05-14, Pages 481-491
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2147/COPD.S63378
• Subjects: Health Sciences, General; Health Sciences, Health Care Management
• Keywords: coils; emphysema; endobronchial valves; sealants; stents; Bronchoscopy; Exercise Therapy; Exercise Tolerance; Forced Expiratory Volume; Humans; Lung; Lung Volume Measurements; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Recovery of Function; Stents; Surveys and Questionnaires; Time Factors; Treatment Outcome; Walking

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.