Cargando…
Lung volume reduction in emphysema: a pragmatic prospective cohort study
Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema. This prospective...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165372/ https://www.ncbi.nlm.nih.gov/pubmed/34084783 http://dx.doi.org/10.1183/23120541.00877-2020 |
_version_ | 1783701307364737024 |
---|---|
author | Dooms, Christophe Blondeel, Astrid Ceulemans, Laurens J. Coolen, Johan Everaerts, Stephanie Demeyer, Heleen Troosters, Thierry Verleden, Geert Van Raemdonck, Dirk Janssens, Wim |
author_facet | Dooms, Christophe Blondeel, Astrid Ceulemans, Laurens J. Coolen, Johan Everaerts, Stephanie Demeyer, Heleen Troosters, Thierry Verleden, Geert Van Raemdonck, Dirk Janssens, Wim |
author_sort | Dooms, Christophe |
collection | PubMed |
description | Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema. This prospective monocentre cohort study evaluated ELVR versus no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a forced expiratory volume in 1 s (FEV(1)) improvement of ⩾100 mL at 3-month follow-up. Changes in FEV(1), residual volume (RV), 6-min walk distance (6MWD) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were evaluated at 6-month follow-up. Hospital stay and treatment-related serious adverse events were monitored. From 106 subjects screened, 38 subjects were enrolled comparing ELVR (n=20) with no-ELVR (n=18). After 6 months’ follow-up, eligible patients were referred for LVRS (n=16) with another 6-month follow-up. At 3-month follow-up, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV(1) improvement of ⩾100 mL. Between-group differences (mean±sem) for ELVR versus no-ELVR at 6-month follow-up were FEV(1) +0.21±0.05 L; RV −0.95±0.21 L; 6MWD 58±17 m and SGRQ −18±5 points. At 6-month follow-up, within-group differences (mean±sem) for LVRS showed FEV(1) +0.27±0.06 L; RV −1.49±0.22 L and 6MWD +75±18 m. Serious adverse events in 81% versus 45% of subjects (p=0.04) and a median hospital stay of 15 versus 5 days (p<0.001) were observed for LVRS versus ELVR, respectively. This pragmatic prospective cohort study supports a clinical approach with ELVR as a less invasive first option and LVRS as powerful alternative in severe heterogeneous emphysema. |
format | Online Article Text |
id | pubmed-8165372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-81653722021-06-02 Lung volume reduction in emphysema: a pragmatic prospective cohort study Dooms, Christophe Blondeel, Astrid Ceulemans, Laurens J. Coolen, Johan Everaerts, Stephanie Demeyer, Heleen Troosters, Thierry Verleden, Geert Van Raemdonck, Dirk Janssens, Wim ERJ Open Res Original Articles Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema. This prospective monocentre cohort study evaluated ELVR versus no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a forced expiratory volume in 1 s (FEV(1)) improvement of ⩾100 mL at 3-month follow-up. Changes in FEV(1), residual volume (RV), 6-min walk distance (6MWD) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were evaluated at 6-month follow-up. Hospital stay and treatment-related serious adverse events were monitored. From 106 subjects screened, 38 subjects were enrolled comparing ELVR (n=20) with no-ELVR (n=18). After 6 months’ follow-up, eligible patients were referred for LVRS (n=16) with another 6-month follow-up. At 3-month follow-up, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV(1) improvement of ⩾100 mL. Between-group differences (mean±sem) for ELVR versus no-ELVR at 6-month follow-up were FEV(1) +0.21±0.05 L; RV −0.95±0.21 L; 6MWD 58±17 m and SGRQ −18±5 points. At 6-month follow-up, within-group differences (mean±sem) for LVRS showed FEV(1) +0.27±0.06 L; RV −1.49±0.22 L and 6MWD +75±18 m. Serious adverse events in 81% versus 45% of subjects (p=0.04) and a median hospital stay of 15 versus 5 days (p<0.001) were observed for LVRS versus ELVR, respectively. This pragmatic prospective cohort study supports a clinical approach with ELVR as a less invasive first option and LVRS as powerful alternative in severe heterogeneous emphysema. European Respiratory Society 2021-05-31 /pmc/articles/PMC8165372/ /pubmed/34084783 http://dx.doi.org/10.1183/23120541.00877-2020 Text en Copyright ©The authors 2021 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Articles Dooms, Christophe Blondeel, Astrid Ceulemans, Laurens J. Coolen, Johan Everaerts, Stephanie Demeyer, Heleen Troosters, Thierry Verleden, Geert Van Raemdonck, Dirk Janssens, Wim Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title | Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title_full | Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title_fullStr | Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title_full_unstemmed | Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title_short | Lung volume reduction in emphysema: a pragmatic prospective cohort study |
title_sort | lung volume reduction in emphysema: a pragmatic prospective cohort study |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165372/ https://www.ncbi.nlm.nih.gov/pubmed/34084783 http://dx.doi.org/10.1183/23120541.00877-2020 |
work_keys_str_mv | AT doomschristophe lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT blondeelastrid lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT ceulemanslaurensj lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT coolenjohan lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT everaertsstephanie lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT demeyerheleen lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT troostersthierry lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT verledengeert lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT vanraemdonckdirk lungvolumereductioninemphysemaapragmaticprospectivecohortstudy AT janssenswim lungvolumereductioninemphysemaapragmaticprospectivecohortstudy |