Lung Volume Reduction Coil Treatment Enables Recovery in Severe COPD Cases

In 11 patients with severe cases of chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure, lung volume reduction coil treatment (LVRC) was associated with significant decreases in carbon dioxide levels and improvement in quality-of-life (QOL) and respiratory function tests, according to study findings published in the International Journal of Chronic Obstructive Pulmonary Disease.

In patients with severe cases of COPD, hyperinflation has served as a major catalyst in the development of chronic hypercapnic respiratory failure. There is no cure for COPD, so current treatment options focus on easing symptoms and reducing exacerbations caused by increases in dyspnea and decreases in exercise performance, physical activity, and QOL. As the study authors note, “Currently, pharmacologically present treatment options have limited efficacy in patients with severe COPD,” warranting further innovations to address this unmet need.

LVRC is a therapeutic option for selected patients with advanced emphysema and has been associated with increases in lung volume and exercise capacity, decreases in dyspnea, and an increase in QOL in patients who were unresponsive to prior medical treatment. The study authors sought to determine whether LVRC treatment would also benefit patients who have severe cases of COPD, with hypercapnic respiratory failure.

They conducted a retrospective study on patients (n = 11) at Global Initiative for Chronic Obstructive Lung Disease, or GOLD, stage 3 or 4 who were having medical treatment and CPAP treatment, with severe COPD (forced expiratory volume [FEV1] <45%) and type-2 respiratory insufficiency (partial pressure of carbon dioxide [PCO₂], 55-80 mm Hg). Patients were administered LVRC treatment in the upper lobes of both lungs and were analyzed based on their respiratory function tests and PCO₂ values in Sifa University hospital, in Turkey, between August 2014 and August 2015. Patients were followed for 12 months using arterial blood gas analysis.

Compared with initial values, LVRC treatment was shown to provide an improvement of 28 meters at month 3, 23 meters at month 6, and 10 meters at month 12 in the 6-minute walk test and a score drop of 27 to 30 through the COPD Assessment Test Questionnaire. Additionally, residual volume and total airway count significantly decreased, indicating LVRC's efficacy at reducing carbon dioxide levels in patients.

Although there was a significant increase in FEV1 at months 3 and 6, the researchers highlight that the increase seen at the end of 1 year was not statistically significant.

Although few patients were examined, the study authors noted that LVRC was shown to be a reliable and efficient treatment method in patients with COPD and emphysema with hypercapnic respiratory failure.

“LVRC treatment may be performed on selected patients with carbon dioxide highness with larger scale studies,” said the study authors.

Reference

Yildiz F. The efficacy of lung volume reduction coil treatment in patients with severe chronic obstructive pulmonary disease (COPD) type II respiratory failure [published online March 3, 2020]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S218785.