Bronchoscopic Lung Volume Reduction

Lung volume-reduction surgery is a proven palliative procedure for emphysema, and in patients with heterogeneous upper-lobe disease as well as low baseline exercise capacity, even mortality benefits can be realized. However, its application is limited by high postoperative morbidity and stringent selection criteria that effectively exclude many patients. This has been the impetus for the development of less-invasive approaches to lung volume reduction. A range of different bronchoscopic techniques, such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been investigated. The underlying physiological mechanisms of the various endoscopic modalities differ and both homogeneous, as well as heterogeneous, emphysema have been targeted. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive, although subjective benefit in dyspnea scores and quality of life is a frequent finding. Improvements in objective outcomes, such as spirometry or exercise tolerance, have been only modest. Refining patient selection and dose of treatment are subjects of ongoing research to improve the efficacy data. Safety profiles are more promising, with rare procedure-related mortality and fewer complications experienced than with surgical lung volume reduction. The field of bronchoscopic lung volume reduction continues to evolve, with the aim of making symptom palliation more available to a wider range of patients at lower risks.