<bold>Introduction:</bold> Patients with advanced COPD and pulmonary emphysema undergo endoscopic valve implantation to improve symptoms and quality of life. As a side effect, some patients report an increase in mucus production due to the implantation of foreign material. Mucus scoring on chest computed tomography (CT) is an objective method of quantifying mucus load. <bold>Aim:</bold> The prospective, single-center MMCOPD study aims to characterize the microbiome, metabolome, mucus load, symptoms (COPD assessment test, CAT) and exacerbation history of COPD patients before and after bronchoscopic interventions. Chest CT scan-based mucus scoring was performed to assess mucus load before and after endoscopic valve implantation, separately for each lung segment. <bold>Results:</bold> 50 patients (emphysema index 34 ± 10%) were analyzed with a mean total mucus score of 5.4 ± 4.9 plugs. 2.9% of all segments were unscorable due to highly diseased regions or motion artifact. 58% of all patients had ≥3 mucus plugs in total. Mucus plugs were more prevalent in lower lobes (highest score in segment LB10) than in upper lobes. For 42 patients with a follow up CT scan, mucus score decreased significantly from 5.5 ± 3.6 to 3.6 ± 4.4 plugs (p=0.002). After exclusion of all unscorable segments the results were still significant. The first two questions on cough and sputum in the CAT score did not change significantly. <bold>Conclusion:</bold> Mucus load is high in patients with pulmonary emphysema. Unexpectedly and fortunately, the mucus score on the chest CT scan decreased after endoscopic valve implantation. This finding needs further evaluation and interpretation.
4Recurrent Chronic Obstructive Pulmonary Disease Exacerbations after Endobronchial Valve Implantation Are Associated with the Presence of Pseudomonas aeruginosa
Recurrent Chronic Obstructive Pulmonary Disease Exacerbations after Endobronchial Valve Implantation Are Associated with the Presence of Pseudomonas aeruginosa
Read more1Endoscopic lung volume reduction (eLVR) with endobronchial valves (EBV) in patients with hypercapnic respiratory failure
Even though eLVR with EBV is an established therapy option for patients with severe emphysema, patients with hypercapnic respiratory failure are usually excluded from treatment. We retrospectively evaluated all patients treated in our department. Hypercapnic respiratory failure was defined as CO 2 ≥ 50mmHg and/or NIV therapy. All patients underwent V/Q-Scan and were evaluated for collateral ventilation (Chartis) to determine the target lobe. CO 2 was analyzed at 3 time points (TP), before, 2-4 days after, and 1-3 months after eLVR. We treated 13 patients (6 bilaterally); (age 61.8 ± 7.6 years). Mean (± SD) FEV 1 before EBV implantation was 0.53 ± 0.15 L (19.8 ± 3.8 % pred.); mean residual volume (RV) was 6.24 ± 1.6 L (287 ± 69.5 % pred.). Left upper lobe was treated 4-times, left lower lobe was treated 7-times, right upper lobe was treated 2-times, right lower lobe 6-times. Patients developed atelectasis in 10/19 (52.6%) cases. Overall, CO 2 was 55.1 ± 9.5 mmHg before and 50.2 ± 12.6 mmHg after 1-3 months (p 2 in patients who developed atelectasis was 57.3 ± 7.74 mmHg before, 53.10 ± 10.6 mmHg at TP2 and 48.7 ± 5.8 mmHg (p 2 levels. The overall pneumothorax rate was 21.1% (4/19 procedures.); all pneumothoraces were treatable by chest tube only. The results of this retrospective analysis show that EBV treatment in patients with hypercapnic respiratory failure is feasible and safe. Successful eLVR may lead to a decrease of CO 2 levels due to improvement in respiratory mechanics. A prospective study has to elucidate the benefit of eLVR in hypercapnic patients.
Read more1Endoscopic lung volume reduction in patients with very low FEV1
Endoscopic lung volume reduction in patients with very low FEV1
38Prediction of Lobar Collateral Ventilation in 25 Patients With Severe Emphysema by Fissure Analysis With CT
Reducing pulmonary volume through implantation of endobronchial valves is a major interest to improve exercise tolerance and survival in patients with severe emphysema. The primary aim of this study was to evaluate how well CT-determined fissure integrity predicts interlobar collateral ventilation. The secondary objective was to show whether there is a relationship between the size of fissural defects and the presence of collateral ventilation. Thirty patients with heterogeneous emphysema (postbronchodilator forced expiratory volume in 1 second [FEV1] = 20-50% predicted and > 50% of emphysema in a lobe) underwent collateral ventilation measurements with a catheter through an occlusive balloon within this target lobe during flexible endoscopy. Two senior thoracic radiologists studied the fissures on thoracic high-resolution CT. Collateral ventilation was successfully measured in 37 target lobes in 25 patients. The fissures surrounding the 37 target lobes were evaluated on CT. For the detection of collateral ventilation, the presence of a fissural defect on CT has a sensitivity, specificity, positive predictive value, and negative predictive value of 95%, 44%, 69%, and 88%, respectively. There was a statistically significant difference in the area of the defect between patients with collateral ventilation and those without collateral ventilation (p = 0.04). Analysis of pulmonary fissures using CT is useful before endoscopic volume reduction because results are well correlated to endoscopic measurements of collateral ventilation. Further study with clinical outcomes is mandatory to determine if and when one test or the other or both should be used in patient selection.
Read more66Incomplete fissures in severe emphysematous patients evaluated with MDCT: Incidence and interobserver agreement among radiologists and pneumologists
Incomplete fissures in severe emphysematous patients evaluated with MDCT: Incidence and interobserver agreement among radiologists and pneumologists
Read more97Pneumothorax following Endobronchial Valve Therapy and Its Impact on Clinical Outcomes in Severe Emphysema
Pneumothorax following Endobronchial Valve Therapy and Its Impact on Clinical Outcomes in Severe Emphysema
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