Health Problem: Chronic obstructive pulmonary disease (COPD) is a progressive, obstructive respiratory disorder in which airways are clogged with mucus; airways and alveoli lose elasticity; or alveoli are thickened, inflamed, or destroyed. Signs and symptoms include ongoing cough, often producing mucus; shortness of breath; audible breathing such as wheezing, whistling, or squeaking; and chest tightness. COPD can cause long-term disability and early death. Lung emphysema is a form of COPD that entails damage to the alveolar sac and/or duct walls and is the form of COPD that bronchoscopic lung volume reduction (BLVR) is intended to treat.
Technology Description: BLVR entails nonsurgical physical intervention with access from the nose or mouth to the lungs, targeting diseased tissue identified by imaging. Valves provide one-way flow that allow air to exit but not enter segments distal to where they are implanted, reducing air trapping, resulting in a reduction in lung volume. Two types of valves are evaluated in this report—endobronchial valves (EBV) and intrabronchial valves (IBV). Endobronchial coils are metal wires that are straight when loaded in a catheter for placement in an airway, and once deployed in the airway return to their predetermined shape to compress diseased tissue and achieve tension in the diseased airway network. This is intended to increase elastic recoil of the lungs and decrease trapped air and hyperinflation.
Controversy: Although BLVR has been proposed as a safer alternative to lung volume reduction surgery (LVRS), there is an absence of evidence directly comparing their outcomes. Further, there are multiple types of BLVR and devices and which, if any, are safest or most effective and for patients with which characteristics warrant clarification.
For adults with lung emphysema:
- How do clinical outcomes of BLVR compare with sham treatment?
- How do clinical outcomes of BLVR compare with medical management?
- How do clinical outcomes of BLVR compare with LVRS?
- How do clinical outcomes of different types of BLVR compare with each other?
- What complications are associated with BLVR, and how do they compare with each other and other treatments?
- Have definitive patient selection criteria for BLVR been established?
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