Endoscopic lung volume reduction coil treatment in patients with very low FEV(1): an observational study

BACKGROUND: Endoscopic lung volume reduction coil (LVRC) treatment is a therapeutic option for selected patients with advanced emphysema. The effects and the safety of endoscopic lung volume reduction in patients with very low forced expired volume in one second (FEV(1)) remain to be determined. This study was conducted to assess the effects and the safety of LVRC treatment in patients with very low FEV(1). METHODS: The study was performed as a retrospective observational study in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf on patients with very low FEV(1), defined as an FEV(1) ⩽ 20% of predicted at baseline in whom LVRC treatment was performed between 1 April 2012 and 28 February 2017. RESULTS: LVRC treatment was performed in 33 patients with very low FEV(1). Of these, 45.5% were female and 54.5% were male. At baseline, mean FEV(1) was 0.46 ± 0.12 liters (15 ± 3% of predicted), mean forced vital capacity (FVC) was 1.61 ± 0.62 liters (42 ± 13% of predicted), mean residual volume (RV) was 6.03 ± 0.81 liters (275 ± 51% of predicted) and 6-minute walk distance was 229 ± 102 m. Bilateral LVRC treatment was completed in 21 of these patients (63.6%). Bilateral LVRC treatment led to significant improvements in functional parameters with an increase in mean FEV(1) from 0.44 ± 0.11 liters to 0.54 ± 0.12 liters (p = 0.001), equivalent to a relative improvement of 24.5 ± 26.9%, an increase in mean FVC from 1.49 ± 0.54 liters to 1.84 ± 0.49 liters (p = 0.001), a decrease in mean RV from 6.27 ± 0.83 liters to 5.83 ± 1.09 liters (p = 0.004) and an improvement in 6-minute walk distance from 218 ± 91 m to 266 ± 96 m (p = 0.01). There were no cases of respiratory failure requiring mechanical ventilation and no deaths. CONCLUSIONS: LVRC treatment was effective and safe in patients with very low FEV(1).