A Comprehensive Approach to Lung Volume Reduction Encompassing Surgical and Endobronchial Treatment of Severe Emphysema
- Journal
- CHEST pulmonary (Q2)
- Published
- 12 July 2025
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Wim Janssens, S Everaerts, N Filipow, C Vandervelde, J Coolen, H Geysen, et al.
- PMID
- 42548516
- DOI
- 10.1016/j.chpulm.2025.100194
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 9 August 2026): Lung volume reduction program not ENT specific
Abstract
BACKGROUND: Randomized controlled trials with lung volume reduction surgery (LVRS) or endobronchial valves (EBVs) have shown clinically significant benefits for specific patients with emphysema. RESEARCH QUESTION: What is the impact of a comprehensive lung volume reduction (LVR) program, with both LVRS and EBVs as treatment options, on patient selection and short- and long-term outcomes in real life? STUDY DESIGN AND METHODS: This study summarizes the results of a prospective comprehensive LVR program in tertiary care, based on 5-year inclusions and follow-up over 1 to 3 years. RESULTS: A total of 429 cases were discussed at a multidisciplinary emphysema board; of these, 131 (30%) were referred for LVRS, 73 (17%) were referred for EBV, 25 (6%) were referred for lung transplantation, and 200 (47%) were referred for usual care. A total of 38 (52%) of the EBV interventions were followed by a second to fourth intervention, including LVRS in 25 (34%). For LVRS first, 72 (55%) and 37 (38%) of patients had a single 1-stage bilateral or unilateral LVRS procedure, and 22 (17%) had a staged procedure. Clinically significant improvements between baseline and follow-up visits were obtained on all outcome dimensions in all LVRS and EBV groups for most of the visits. Responder rates varied between 50% and 80% at 3 months to 1 year and slowly declined in the second year. Transplant-free survival over 2.5 years, adjusted for age and BODE Index at baseline, was significantly better for the EBV intervention (hazard ratio, 0.14; 95% CI, 0.04-0.44) and borderline significant for LVRS (hazard ratio, 0.7; 95% CI, 0.45-1.2) compared with the nonintervention group. INTERPRETATION: LVR programs should cover both surgical and bronchoscopic interventions to maximize eligibility and to improve outcome and prognosis of highly symptomatic patients with severe emphysema.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.