Valve Treatment Can Improve Lung Function in Emphysema

Patients who have emphysema without interlobar collateral ventilation experience improved pulmonary function and have greater capacity for exercise when they receive endobronchial valve treatment, according to a recent study published in the New England Journal of Medicine. Karin Klooster of the Department of Pulmonary Diseases at the university of Groningen in the Netherlands and colleagues conducted an investigation “to examine the effectiveness of endobronchial valve treatment in patients with severe emphysema in whom the absence of collateral ventilation had been proved.”

The study was randomized and controlled and participants were older than 35, had stopped smoking more than 6 months prior, and met various lung capacity values, as well as having "a lobe that was determined to be a target for treatment, with a complete or nearly complete fissure between the target lobe and the adjacent lobe.” Half of the patients received endobronchial valve treatment and half standard care.

The primary outcome measure was improvement from baseline to 6 months in forced expiratory volume and forced vital capacity, and 6- minute walk distance. There were 68 patients included in the randomization, but 10 were unable to complete the 6 months follow up. Thirty-four patients underwent the endobronchial valve treatment. All of the primary outcome measures were significantly greater in the patients who received the endobronchial valve treatment.

The researchers “found that endobronchial valve treatment in patients with emphysema and a proven absence of interlobar collateral ventilation provided a measurable clinical benefit, with significantly improved lung function, exercise capacity, and quality of life, as compared with usual care.” The most frequent (18%) adverse effect was pneumothorax, which was treated with standard care, and all cases occurred within one day of the endobronchial valve treatment, while the patients were still hospitalized. Since pneumothorax is potentially life-threatening in people with emphysema, the researchers stressed that careful monitoring is essential.