COPD Symptoms Improved in Case Study of Endobronchial Valve Treatment

Endobronchial valve (EBV) treatment helped improve symptoms of dyspnea, or shortness of breath, in a patient with chronic obstructive pulmonary disease (COPD) by reducing lung hyperinflation, according to a case study in Medicina.

The patient was a 69-year-old woman with COPD who displayed worsening symptoms of dyspnea over a span of 6 years. She was a former smoker who amassed a total of 40 pack-years and had quit smoking 17 years before being referred for the procedure.

Chest imaging showed heterogenous emphysema and severe hyperinflation in the right lower lobe of her lungs. She scored a 24 out of 40 on the COPD Assessment Test (CAT), suggesting that her daily life was significantly affected by the disease. She reported a sedentary lifestyle and reported grade 2 to 3 dyspnea (ie, needed to stop for breath after walking 200-300 meters). She walked 342 meters on a 6-minute walking test (6MWT). Results of pulmonary function tests (PFTs) showed severe airway obstruction. According to spirometry testing, she met the Global Initiative for Obstructive Lung Disease (GOLD) criteria for stage 3 COPD.

The patient was included in a pulmonary rehabilitation program prior to EBV treatment. She was believed to be a candidate with the potential to experience positive results from EBV lung volume reduction treatment. After 3 months of rehabilitation, her dyspnea was mildly improved. Results of the 6MWT were unchanged, and her chest auscultation and PFT results showed no major signs of improvement.

During the procedure, 2 EBVs were placed in the lower right lobe of the patient’s lungs with the aim of achieving collapse of emphysematous lung areas to reduce lung volume. After 1 month, the patient reported significant improvement in her symptoms. The improvements were confirmed 4 months after the treatment. Dyspnea no longer limited her activities of daily life. Her CAT score substantially improved to 10 out of 20, and she walked 399 meters in a 6MWT. Although chest auscultation still revealed sounds of diminished breath on her posterior right side, the asymmetry of her lungs was reduced.

Following the procedure, it was found that the patient no longer met the GOLD criteria for COPD. Substantial improvements on PFTs were observed. An extremely significant result, an 80% increase in forced expiratory volume after 1 second, was also found. Improvements were sustained for 3 years, the time of the latest controlled study, after the EBV procedure. Although the patient’s disease was not necessarily cured, the study shows the potential benefits of lung volume reduction treatment.

The authors wrote that endobronchial techniques like EBV procedures could present a safer alternative to lung volume reduction surgery, which is effective but has been hindered by risks of perioperative morbidity and mortality. They also noted that their findings point to the value of improving selection criteria for lung volume reduction procedure recipients to ensure that potential candidates are those who could experience the most positive results.

Dyspnea in patients with COPD is one of the most disabling symptoms of the disease. It is often caused by pulmonary hyperinflation, which occurs when air becomes trapped in the lungs. Damage caused by COPD decreases the elasticity of the lungs, interfering with the exhalation of air. EBV are small, one-way valves that are implanted in airways of the pulmonary systems. They allow air to flow freely during exhalation but limit the flow of air into a damaged lung compartment, preventing hyperinflation.

Reference

Marchand E, d’Odemont JP, Dupont MV. A patient with GOLD stage 3 COPD "cured" by one-way endobronchial Valves. Medicina (Kaunas). 2019;55(3):65. doi: 10.3390/medicina55030065.