Bronchoscopic Lung Volume Reduction Is Springing with Potential for Patients with Homogenous Emphysema

摘要

COPD is currently the third leading cause of death globally [1] and has a prevalence of >5% in both Europe [2] and the USA [3]. It is the cause of physical impairment, incapacity and a reduced quality of life as well as extensive utilisation of healthcare resources. Reducing the volume of hyperinflated lungs is a logical approach to treatment, especially if this can be achieved by removing or shrinking the most diseased portions of the lung, thereby contributing to the least gas exchange. Lung volume reduction surgery, where the worst affected areas of em-physematous lungs are resected, improves survival and quality of life, but is associated with significant morbidity and a 5.5% mortality [4]. The message from the NETT (National Emphysema Treatment Trial) and a Cochrane collaboration analysis was that patients with homogenous emphysema have the greatest risk for mortality and morbidity [4, 5]. Thus, a view developed that only a minority of patients with emphysema, those with heterogeneous upper-lobe disease and a low exercise capacity ben-efitted, and then at a high financial cost. There has therefore been a push in the last decade to develop simpler, safer and cheaper methods of emulating the volume loss achieved by surgical resection.