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Recent Advances in Chest Medicine |

Lung Volume Reduction Therapies for Advanced Emphysema: An Update

Robert L. Berger, MD; Malcolm M. DeCamp, MD; Gerard J. Criner, MD, FCCP; Bartolome R. Celli, MD, FCCP
Author and Funding Information

From the Division of Cardiothoracic Surgery (Dr Berger), Beth Israel Deaconess Medical Center, Boston, MA; Division of Thoracic Surgery (Dr DeCamp), Northwestern Memorial Hospital, Chicago, IL; Division of Pulmonary and Critical Care Medicine (Dr Criner), Temple University School of Medicine, Philadelphia, PA; and Division of Pulmonary and Critical Care Medicine (Dr Celli), Brigham and Women’s Hospital, Boston, MA.

Correspondence to: Robert L. Berger, MD, Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Deaconess, Ste 201, Boston, MA 02215; e-mail: robert_berger@hms.harvard.edu


For editorial comment see page 243

Funding/Support: This work was supported by the Thoracic Foundation (Overholt), Boston, MA.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):407-417. doi:10.1378/chest.09-1822
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Observational and randomized studies provide convincing evidence that lung volume reduction surgery (LVRS) improves symptoms, lung function, exercise tolerance, and life span in well-defined subsets of patients with emphysema. Yet, in the face of an estimated 3 million patients with emphysema in the United States, < 15 LVRS operations are performed monthly under the aegis of Medicare, in part because of misleading reporting in lay and medical publications suggesting that the operation is associated with prohibitive risks and offers minimal benefits. Thus, a treatment with proven potential for palliating and prolonging life may be underutilized. In an attempt to lower risks and cost, several bronchoscopic strategies (bronchoscopic emphysema treatment [BET]) to reduce lung volume have been introduced. The following three methods have been tested in some depth: (1) unidirectional valves that allow exit but bar entry of gas to collapse targeted hyperinflated portions of the lung and reduce overall volume; (2) biologic lung volume reduction (BioLVR) that involves intrabronchial administration of a biocompatible complex to collapse, inflame, scar, and shrink the targeted emphysematous lung; and (3) airway bypass tract (ABT) or creation of stented nonanatomic pathways between hyperinflated pulmonary parenchyma and bronchial tree to decompress and reduce the volume of oversized lung. The results of pilot and randomized pivotal clinical trials suggest that the bronchoscopic strategies are associated with lower mortality and morbidity but are also less efficient than LVRS. Most bronchoscopic approaches improve quality-of-life measures without supportive physiologic or exercise tolerance benefits. Although there is promise of limited therapeutic influence, the available information is not sufficient to recommend use of bronchoscopic strategies for treating emphysema.

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