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Screening for Bronchoscopic Lung Volume Reduction: Reasons for Not Receiving Interventional Treatment
- Source :
- Lung. 198:221-228
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- Evidence for bronchoscopic lung volume reduction (BLVR) is based on phase 2 studies and small randomized controlled trials with in- and exclusion criteria defining a therapeutic window and contraindications. Little is known about the applicability in routine clinical practice. Which percentage of patients with severe emphysema referred to a specialized treatment center for BLVR is ultimately suitable for interventional bronchoscopic treatment? What is the relevance of the different contraindications? Retrospective evaluation of emphysema patients referred to Asklepios Fachkliniken Munich-Gauting for BLVR between January 2014 and June 2015. 138 patients were referred for evaluation of BLVR. 38 patients (27.5%) underwent BLVR procedures (valves n = 18; coils n = 18; thermal vapor ablation n = 2). 100 patients (72.5%) were deemed not eligible for BLVR based on the following contraindications: 34% emphysema morphology and emphysema-related findings (severe homogeneous emphysema, extensive pleuropulmonary adhesions, postinflammatory scaring with natural volume reduction, giant bullae), 16% active smoking; 9% pulmonary function not within indication range; 8% unexpected CT findings (nodules, cancer, interstitial disease); 8% chronic ventilatory failure; 8% patient refused BLVR; 5% relevant comorbidity; 5% frequent exacerbations, 3% preserved quality of life, 4% other. BLVR is a therapeutic option for highly selected patients. In our cohort, one in four could be treated. These data highlight the limitations of BLVR under real-life conditions.
- Subjects :
- Ablation Techniques
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Vital Capacity
Eligibility Determination
Tissue Adhesions
Bronchoscopic lung volume reduction
Pulmonary function testing
law.invention
Contraindications, Procedure
Treatment Refusal
Cicatrix
03 medical and health sciences
0302 clinical medicine
Quality of life
Randomized controlled trial
law
Forced Expiratory Volume
Bronchoscopy
medicine
Humans
030212 general & internal medicine
Pneumonectomy
Aged
Retrospective Studies
Interventional treatment
business.industry
Patient Selection
Smoking
Total Lung Capacity
Cancer
Middle Aged
Surgical Instruments
medicine.disease
Comorbidity
Surgery
Residual Volume
Pulmonary Emphysema
030228 respiratory system
Cohort
Disease Progression
Female
business
Subjects
Details
- ISSN :
- 14321750 and 03412040
- Volume :
- 198
- Database :
- OpenAIRE
- Journal :
- Lung
- Accession number :
- edsair.doi.dedup.....bf035cbcfc6889b0a223db59559d3aee