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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...

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Autores principales: Dooms, Christophe, Blondeel, Astrid, Ceulemans, Laurens J., Coolen, Johan, Everaerts, Stephanie, Demeyer, Heleen, Troosters, Thierry, Verleden, Geert, Van Raemdonck, Dirk, Janssens, Wim
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
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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.
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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
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