Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data

Sharyn A Roodenburg; Jorine E Hartman; Gaëtan Deslée; Felix J F Herth; Karin Klooster; Frank C Sciurba; Pallav L Shah; Arschang Valipour; Zaid Zoumot; Dirk-Jan Slebos

doi:10.1159/000524148

Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data

Respiration. 2022;101(7):697-705. doi: 10.1159/000524148. Epub 2022 Apr 11.

Authors

Sharyn A Roodenburg^{1

2}, Jorine E Hartman^{1

2}, Gaëtan Deslée³, Felix J F Herth^{4

5}, Karin Klooster^{1

2}, Frank C Sciurba⁶, Pallav L Shah^{7

8

9}, Arschang Valipour¹⁰, Zaid Zoumot¹¹, Dirk-Jan Slebos^{1

2}

Affiliations

¹ Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.
⁴ Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
⁵ Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany.
⁶ Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁷ Royal Brompton Hospital, London, United Kingdom.
⁸ Chelsea & Westminster Hospital, London, United Kingdom.
⁹ National Heart and Lung Institute, Imperical College London, London, United Kingdom.
¹⁰ Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Floridsdorf, Austria.
¹¹ Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

Abstract

Background: Lung volume reduction coil (LVR-coil) treatment provides a minimally invasive treatment option for severe emphysema patients which has been studied in multiple clinical trials.

Objectives: The aim of the study was to assess the effect of LVR-coil treatment on pulmonary function, quality of life, and exercise capacity using individual participant data.

Method: PubMed, Web of Science, and EMBASE were searched until May 17, 2021. Prospective single-arm and randomized controlled trials that evaluated the effect of LVR-coil treatment on forced expiratory volume in 1 s (FEV1), residual volume (RV), St. George Respiratory Questionnaire (SGRQ) total score, and/or 6-min walk distance (6MWD) and were registered in an official clinical trial database were eligible for inclusion. Individual patient data were requested, and a linear mixed effects model was used to calculate overall treatment effects.

Results: Eight trials were included in the final analysis, representing 680 individual patients. LVR-coil treatment resulted in a significant improvement in FEV1 at 3- (0.09 L [95% confidence interval (95% CI): 0.06-0.12]) and 6-month follow-up (0.07 L [95% CI: 0.03-0.10]), a significant reduction in RV at 3- (-0.45L [95% CI: -0.62 to -0.28]), 6- (-0.33L [95% CI: -0.52 to -0.14]), and 12-month follow-up (-0.36L [95% CI: -0.64 to -0.08]), a significant reduction in SGRQ total score at 3- (-12.3 points [95% CI: -15.8 to -8.8]), 6- (-10.1 points [95% CI: -12.8 to -7.3]), and 12-month follow-up (-9.8 points [95% CI: -15.0 to -4.7]) and a significant increase in 6MWD at 3-month follow-up (38 m [95% CI: 18-58]).

Conclusions: LVR-coil treatment in emphysema patients results in sustained improvements in pulmonary function and quality of life and shorter lived improvements in exercise capacity. Since the owner of this LVR-coil has decided to stop the production and newer generations LVR-coils are currently being developed, these results can act as a reference for future studies and clinical guidance.

Keywords: Bronchoscopic lung volume reduction; Bronchoscopy; Chronic obstructive pulmonary disease; Emphysema; Meta-analysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Bronchoscopy / methods
Emphysema* / surgery
Forced Expiratory Volume
Humans
Pneumonectomy / methods
Prospective Studies
Pulmonary Emphysema* / surgery
Quality of Life
Treatment Outcome