Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema

Objectives: In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema.
Methods: The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient’s records, including the modified Medical Research Council (MRC) dyspnea score, the St. George’s Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated.
Results: Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month’s mMRC score was 2.62 (p=0.007), and the mean of the 12th month’s mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients’ preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients’ preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756).
Conclusion: It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

Þiddetli Amfizemli Hastalarda Bronkoskopik Akciðer Hacim Azaltýcý Sarmal Uygulamasýnýn Etkinliði ve Güvenilirliði

Amaç: Geçmiþ yýllarda aðýr amfizemin medikal olmayan tedavisi için cerrahiden faydalanýlýrdý. Ancak son yýllarda bronkoskopik hacim azaltma tedavisi daha az invaziv olmasý nedeniyle daha sýk tercih edilir olmuþtur. Bronkoskopik sarmal tedavi de bu yöntemlerden en sýk uygulanan tekniktir. Araþtýrmanýn amacý, aðýr amfizemli hastalarda bronkoskopik hacim azaltýcý sarmal tedavisinin etkinliðini ve güvenliðini incelemektir.
Metod: 2015-2017 yýllarý arasýnda bronþiyal volüm azaltýcý sarmal tedavisi uygulanan hastalar retrospektif olarak incelendi. Ýþlemden sonra hastalar üç aylýk aralýklarla bir yýl boyunca takip edildi. Modifiye Medical Research Council (mMRC) dispne skoru, St George'un Solunum Anketi (SGRQ) yaþam kalitesi ölçeði, 6 dakikalýk yürüme mesafesi (6-DYT), solunum fonksiyon testleri ve görülen komplikasyon kayýtlarý ile hastalar güvenlik ve etkinlik açýsýndan deðerlendirildi.
Bulgular: Onüçü (%81) erkek, üçü (%19) kadýn 16 hastanýn yaþ ortalamasý 62±6.9 idi. Hastalarýn preoperatif mMRC klinik dispne skoru ortalama 3,38, üçüncü ay mMRC skoru ortalama 2,62 (p=0,007), 12. ay mMRC ortalamasý 2,37 (p=0,003) idi. Preoperatif SGRQ yaþam kalitesi parametresi 71,95±15,7, üçüncü ay 66,7±16,2 (p=0,007), 12. ay 62,9±16,4 (p=0,003) idi. Preoperatif ortalama 6-DYT sýrasýyla 247,25±112,36 m, üçüncü ay 264,25±95 m (p=0,148), 12. ay 317±122,9 m (p=0,034) idi. Hastalarýn ameliyat öncesi rezidüel volüm 5,28±1,96 L, üçüncü ay 4,52±1,35 L (p=0,023), 12. ay 4,545±1,83 L (p=0,163) olarak hesaplandý. Hastalarýn preoperatif birinci saniye zorlu ekspiratuar volüm deðerleri sýrasýyla 0,79±0,29 L, üçüncü ay 0,79±0,3 L (p=0,917), 12. ay 0,86±0,3 L (p=0,756) idi.
Sonuç: Solunum fonksiyon testi parametrelerindeki düzelmeden ziyade nefes darlýðýný azaltan, günlük yaþam kalitesini arttýran, etkin ve güvenilir bir iþlem olan bronkoskopik hacim azaltýcý sarmal tedavisi daha da yaygýnlaþacak gibi görünmektedir. (SETB-2023-02-030)