Emphysema: Lung Reduction Coils Effective

A recent study published in the Journal of American Medicine Association found that bronchoscopic treatment with nitinol coils works better than usual care for patients with severe emphysema. Gaetan Deslee, MD, PhD, of the Pulmonology Service at the University of Reims Hospital in Reims, France, and colleagues conducted the study.

Emphysema is one of the main components of chronic obstructive pulmonary disease (COPD) and treatments for it are limited. Lack of lung elasticity is one of the characteristics of emphysema, which leads to the limited ability to exercise as well as an overall lower quality of life. One treatment is lung volume reduction surgery, but there are risks. A number of minimally invasive treatments are under investigation, including endobronchial valves. This study was done in order to “evaluate the efficacy, safety, cost, and cost-effectiveness of nitinol coils in the treatment of severe emphysema.”

According to the authors, “the primary outcome was improvement of at least 54 m in the 6-minute walk test at 6 months.” Secondary outcomes were “changes at 6 and 12 months in the 6-minute walk test, lung function, quality of life as assessed by St George’s Respiratory Questionnaire, morbidity, mortality, total cost, and cost-effectiveness.”

One hundred patients were randomized for this study. Of those, 50 received usual care, and 50 receive the nitinol coil. In the coil group, 47 received bilateral coil treatment and 3 received unilateral coil treatment. At the 6-month mark, 44 patients in each group performed the 6-minute walk test. The researchers found that 36% of the coil group and 18% of the usual care group achieved an improvement of at least 54 m.

As for secondary outcomes, “at 6 months improvements from baseline were significant in the coil group compared with the usual care group in the 6-minute walk test.” Further, “at 12 months, improvements from baseline were significant in the coil group compared with the usual care group” for all secondary outcomes measured except the 6-minute walk test.” Regarding the economic evaluation, “at 1 year the mean cost difference per patient was $47,908.”

The researchers concluded that for patients with severe emphysema, “bronchoscopic treatment with nitinol coils compared with usual care resulted in improved exercise capacity with high short-term costs.” They suggest that “further study is needed to assess durability of benefit and long-term cost implications.”