Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia
Pavlina Lenga, Christian Grah, Christoph Ruwwe‐Glösenkamp, Jacopo Saccomanno, Jens C. Rückert, Stephan Eggeling, Sven Gläser, S Kurz, Stephan Eisenmann, M. Krüger, Bernd Schmidt, Paul Schneider, Stefan Andreas, Marc Hinterthaner, Joachim Pfannschmidt, Andreas Gebhardt, Franz Stanzel, Angélique Holland, Andreas Kirschbaum, Birgit Becke, Ralf‐Harto Hübner, on behalf of the Lung Emphysema Registry Study Group
Abstract
<b><i>Background:</i></b> Robust clinical evidence on the efficacy and safety of endoscopic lung volume reduction (ELVR) with one-way valves in patients with severe lung emphysema with chronic hypercapnic respiratory failure is lacking. <b><i>Objective:</i></b> The aim of this study was to compare patient characteristics, clinical outcome measures, and incidences of adverse events between patients with severe COPD undergoing ELVR with one-way valves and with either a partial pressure of carbon dioxide (pCO<sub>2</sub>) of ≤45 mm Hg or with pCO<sub>2</sub> &#x3e;45 mm Hg. <b><i>Methods:</i></b> This was a multicentre prospective study of patients with severe lung disease who were evaluated based on lung function, exercise capacity (6-min walk test [6-MWT]), and quality-of-life tests. <b><i>Results:</i></b> Patients with pCO<sub>2</sub> ≤45 mm Hg (<i>n</i> = 157) and pCO<sub>2</sub> &#x3e;45 mm Hg (<i>n</i> = 40) showed similar baseline characteristics. Patients with pCO<sub>2</sub> ≤45 mm Hg demonstrated a significant increase in forced expiratory volume in 1 s (<i>p</i> &#x3c; 0.001), a significant decrease in residual volume (RV) (<i>p</i> &#x3c; 0.001), and significant improvements in the quality of life and 6-MWT at the 3-month follow-up. Patients with pCO<sub>2</sub> &#x3e;45 mm Hg had significant improvements in RV only (<i>p</i> &#x3c; 0.05). There was a significant decrease in pCO<sub>2</sub> between baseline and follow-up in hypercapnic patients, relative to the decrease in patients with pCO<sub>2</sub> ≤45 mm Hg (<i>p</i> = 0.008). Patients who were more hypercapnic at baseline showed a greater reduction in pCO<sub>2</sub> after valve placement (<i>r</i> = −0.38, <i>p</i> &#x3c; 0.001). Pneumothorax was the most common adverse event in both groups. <b><i>Conclusions:</i></b> ELVR with one-way valves seems clinically beneficial with a remarkably good safety profile for patients with chronic hypercapnic respiratory failure.