Efficacy of Bronchoscopic Lung Volume Reduction by Endobronchial Valves in Patients with Heterogeneous Emphysema: Report on the First Asian Cases

Abstract

Although many patients with severe emphysema have benefited from bronchoscopic lungvolume reduction (BLVR) worldwide, experience of BLVR in Asian emphysema patients isscarce. Between July 2012 and March 2013, seven patients with advanced heterogeneousemphysema underwent BLVR in the Asan Medical Center. They had severe dyspnea andpoor lung function (Modified Medical Research Council dyspnea scale 3-4; median forcedexpiratory volume in 1 sec [FEV1], 0.59 L [19.0 % predicted]; median 6-min walk distance[6MWD], 195 m). Endobronchial valves were inserted into the target lobe which was mosthyperinflated and least perfused, and had no collateral ventilation with other lobes. Sixpatients showed clinical improvement after 1 month. Of them, 2 patients improved todyspnea scale 1 and 4 patients did to scale 2 (P = 0.026). The median FEV1 increased from0.59 to 0.89 L (51%; P = 0.028) and the median 6MWD increased from 195 to 252 m(29.2%; P = 0.028). Two patients developed a pneumothorax (one requiring drainage) andone patient experienced slight hemoptysis; however, there were no other serious adverseevents. BLVR is effective in Asian advanced emphysema patients, with noted clinicalimprovements in lung function and exercise capacity.