Endoscopic lung volume reduction (ELVR) with endobronchial valves reduces chronic obstructive pulmonary disease (COPD) exacerbations within 1 year of the procedure in patients with severe emphysema, according to study findings published in Respiratory Medicine.
The lack of mid- or long-term data regarding the exacerbation rate after ELVR with endobronchial valves led investigators to analyze exacerbation rates before and after implantation of endobronchial valves and to assess possible predictors of COPD exacerbation.
The investigators conducted a monocentric retrospective analysis that included 129 patients with severe emphysema (mean [SD] age, 64.1 [7.7] years; 57% female) who underwent ELVR from 2016 to 2019 at the Thoraxklinik at University of Heidelberg, Germany. The primary study outcome was decrease in exacerbations at 1 year after ELVR. Secondary outcomes included improvements in forced expiratory volume in 1 second (FEV1) and residual volume (RV).
At baseline, 62% of patients were on triple inhalation therapy, 14% on oral cortisone long-term therapy, and 22% on roflumilast. Among all patients, 18% had eosinophil counts of at least 300 µL and 54% had eosinophil counts below 150 µL. Body mass index showed 36% of patients were overweight and 16% of patients were underweight. Mean nicotine consumption was 43.4 package years. Additional significant comorbidities included arterial hypertension (65%), respiratory insufficiency type II (41%) and type I (38%), and hyperlipidemia (19%).
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ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved.
The investigators noted patients experienced a mean (SD) of 2.5 (2.2) moderate and severe exacerbations in the year prior to ELVR treatment. In the first year after ELVR, the number of exacerbations significantly decreased to 1.8 (2.2) (P =.009). Overall, 90% of patients experienced at least 1 exacerbation in the year prior to ELVR vs 68% 1 year after ELVR.
The development of complete lobar atelectasis was associated with the decrease in exacerbation rate (r=0.228; P =.009). Among the 41 patients with complete lobar atelectasis, the decrease in exacerbations dropped from 2.8 (2.0) to 1.4 (1.8) exacerbations (P <.001), and statistically significant improvements were noted for FEV1, RV, vital capacity, total lung capacity, and the 6-minute walk distance.
Subgroup analyses for patients with common comorbidities and risk factors in COPD exacerbations indicated a statistically significant reduction of the COPD exacerbation rate after ELVR for women, patients with normal weight, patients younger than 65 years old, patients with FEV1 less than 0.81, and patients with RV less than 5.1L.
The investigators found the number of exacerbations in the year following ELVR significantly correlated with the number of exacerbations in the year prior to ELVR (ie, exacerbation history is the primary predictor of future exacerbations).
Study limitations include the retrospective design and the assumption of no bias in patient selection.
“ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved,” the investigators concluded. The study authors wrote, “ELVR with endobronchial valves is feasible in patients with a history of frequent exacerbations; these patients should not be excluded from therapy after careful and individual patient selection.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
