Changes in ventilation and perfusion following lower lobe endoscopic lung volume reduction (ELVR) with endobronchial valves in severe COPD

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Abstract

Background: We have previously reported significant improvements in ventilation and perfusion (VQ) and V/Q matching in the contralateral lung, especially the non‐targeted lower zone in patients with severe COPD following upper lobe ELVR with endobronchial valves. However, V/Q changes after lower lobe ELVR have not been described. Methods: Seven patients with lower lobe heterogeneous emphysema underwent unilateral lower lobe ELVR at Macquarie University Hospital. Lung function tests, 6‐minute walk tests (6MWT), St George’s Respiratory Questionnaire (SGRQ) and planar differential VQ scans were performed at baseline and at 1, 3 and 12 months post‐ELVR. Results: Compared to baseline, patients showed significant improvements in FEV1 (0.83 ± 0.09L‐0.97 ± 0.12L, p < 0.05), 6MWD (200.33 ± 56.54 m‐274.24 ± 48.03 m, p < 0.05) and SGRQ (61.13 ± 5.33‐42.86 ± 6.99, p < 0.05) at 3 months after ELVR. This improvement was maintained at 12 months. There was a corresponding significant improvement in the differential ventilation (30.21 ± 3.04%‐37.82 ± 3.76%, p < 0.05) and perfusion (31.77 ± 2.53%‐35.60 ± 2.58%, p < 0.05) of the contralateral non‐targeted upper zone. Conclusions: Within the limitations of a small sample size, we have found that in heterogeneous severe COPD patients undergoing ELVR targeting the lower lobes, there are clinical and PFT improvements similar to that reported in ELVR targeting upper lobes. Contralateral improvement in V/Q matching also occurs following lower lobe ELVR with the greatest improvement in the contralateral upper zone, suggesting the contralateral upper lobe should be the least affected lobe if the lower lobe is targeted in ELVR. These findings need to be confirmed in a study with a larger number of patients.
LanguageEnglish
Pages453-459
Number of pages7
JournalClinical Respiratory Journal
Volume13
Issue number7
Early online date21 Apr 2019
DOIs
Publication statusPublished - Jul 2019

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Pneumonectomy
Chronic Obstructive Pulmonary Disease
Ventilation
Perfusion
Respiratory Function Tests
Emphysema
Sample Size
Lung

Keywords

  • bronchoscopy lung volume reduction
  • COPD
  • perfusion
  • ventilation

Cite this

@article{129b4ddb03d5463d965dd35a82584c0c,
title = "Changes in ventilation and perfusion following lower lobe endoscopic lung volume reduction (ELVR) with endobronchial valves in severe COPD",
abstract = "Background: We have previously reported significant improvements in ventilation and perfusion (VQ) and V/Q matching in the contralateral lung, especially the non‐targeted lower zone in patients with severe COPD following upper lobe ELVR with endobronchial valves. However, V/Q changes after lower lobe ELVR have not been described. Methods: Seven patients with lower lobe heterogeneous emphysema underwent unilateral lower lobe ELVR at Macquarie University Hospital. Lung function tests, 6‐minute walk tests (6MWT), St George’s Respiratory Questionnaire (SGRQ) and planar differential VQ scans were performed at baseline and at 1, 3 and 12 months post‐ELVR. Results: Compared to baseline, patients showed significant improvements in FEV1 (0.83 ± 0.09L‐0.97 ± 0.12L, p < 0.05), 6MWD (200.33 ± 56.54 m‐274.24 ± 48.03 m, p < 0.05) and SGRQ (61.13 ± 5.33‐42.86 ± 6.99, p < 0.05) at 3 months after ELVR. This improvement was maintained at 12 months. There was a corresponding significant improvement in the differential ventilation (30.21 ± 3.04{\%}‐37.82 ± 3.76{\%}, p < 0.05) and perfusion (31.77 ± 2.53{\%}‐35.60 ± 2.58{\%}, p < 0.05) of the contralateral non‐targeted upper zone. Conclusions: Within the limitations of a small sample size, we have found that in heterogeneous severe COPD patients undergoing ELVR targeting the lower lobes, there are clinical and PFT improvements similar to that reported in ELVR targeting upper lobes. Contralateral improvement in V/Q matching also occurs following lower lobe ELVR with the greatest improvement in the contralateral upper zone, suggesting the contralateral upper lobe should be the least affected lobe if the lower lobe is targeted in ELVR. These findings need to be confirmed in a study with a larger number of patients.",
keywords = "bronchoscopy lung volume reduction, COPD, perfusion, ventilation",
author = "Li Yang and Kelvin Hsu and Williamson, {Jonathan P.} and Peters, {Matthew J.} and Kevin Ho-Shon and Ing, {Alvin J.}",
year = "2019",
month = "7",
doi = "10.1111/crj.13031",
language = "English",
volume = "13",
pages = "453--459",
journal = "Clinical Respiratory Journal",
issn = "1752-6981",
publisher = "Wiley-Blackwell, Wiley",
number = "7",

}

TY - JOUR

T1 - Changes in ventilation and perfusion following lower lobe endoscopic lung volume reduction (ELVR) with endobronchial valves in severe COPD

AU - Yang, Li

AU - Hsu, Kelvin

AU - Williamson, Jonathan P.

AU - Peters, Matthew J.

AU - Ho-Shon, Kevin

AU - Ing, Alvin J.

PY - 2019/7

Y1 - 2019/7

N2 - Background: We have previously reported significant improvements in ventilation and perfusion (VQ) and V/Q matching in the contralateral lung, especially the non‐targeted lower zone in patients with severe COPD following upper lobe ELVR with endobronchial valves. However, V/Q changes after lower lobe ELVR have not been described. Methods: Seven patients with lower lobe heterogeneous emphysema underwent unilateral lower lobe ELVR at Macquarie University Hospital. Lung function tests, 6‐minute walk tests (6MWT), St George’s Respiratory Questionnaire (SGRQ) and planar differential VQ scans were performed at baseline and at 1, 3 and 12 months post‐ELVR. Results: Compared to baseline, patients showed significant improvements in FEV1 (0.83 ± 0.09L‐0.97 ± 0.12L, p < 0.05), 6MWD (200.33 ± 56.54 m‐274.24 ± 48.03 m, p < 0.05) and SGRQ (61.13 ± 5.33‐42.86 ± 6.99, p < 0.05) at 3 months after ELVR. This improvement was maintained at 12 months. There was a corresponding significant improvement in the differential ventilation (30.21 ± 3.04%‐37.82 ± 3.76%, p < 0.05) and perfusion (31.77 ± 2.53%‐35.60 ± 2.58%, p < 0.05) of the contralateral non‐targeted upper zone. Conclusions: Within the limitations of a small sample size, we have found that in heterogeneous severe COPD patients undergoing ELVR targeting the lower lobes, there are clinical and PFT improvements similar to that reported in ELVR targeting upper lobes. Contralateral improvement in V/Q matching also occurs following lower lobe ELVR with the greatest improvement in the contralateral upper zone, suggesting the contralateral upper lobe should be the least affected lobe if the lower lobe is targeted in ELVR. These findings need to be confirmed in a study with a larger number of patients.

AB - Background: We have previously reported significant improvements in ventilation and perfusion (VQ) and V/Q matching in the contralateral lung, especially the non‐targeted lower zone in patients with severe COPD following upper lobe ELVR with endobronchial valves. However, V/Q changes after lower lobe ELVR have not been described. Methods: Seven patients with lower lobe heterogeneous emphysema underwent unilateral lower lobe ELVR at Macquarie University Hospital. Lung function tests, 6‐minute walk tests (6MWT), St George’s Respiratory Questionnaire (SGRQ) and planar differential VQ scans were performed at baseline and at 1, 3 and 12 months post‐ELVR. Results: Compared to baseline, patients showed significant improvements in FEV1 (0.83 ± 0.09L‐0.97 ± 0.12L, p < 0.05), 6MWD (200.33 ± 56.54 m‐274.24 ± 48.03 m, p < 0.05) and SGRQ (61.13 ± 5.33‐42.86 ± 6.99, p < 0.05) at 3 months after ELVR. This improvement was maintained at 12 months. There was a corresponding significant improvement in the differential ventilation (30.21 ± 3.04%‐37.82 ± 3.76%, p < 0.05) and perfusion (31.77 ± 2.53%‐35.60 ± 2.58%, p < 0.05) of the contralateral non‐targeted upper zone. Conclusions: Within the limitations of a small sample size, we have found that in heterogeneous severe COPD patients undergoing ELVR targeting the lower lobes, there are clinical and PFT improvements similar to that reported in ELVR targeting upper lobes. Contralateral improvement in V/Q matching also occurs following lower lobe ELVR with the greatest improvement in the contralateral upper zone, suggesting the contralateral upper lobe should be the least affected lobe if the lower lobe is targeted in ELVR. These findings need to be confirmed in a study with a larger number of patients.

KW - bronchoscopy lung volume reduction

KW - COPD

KW - perfusion

KW - ventilation

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DO - 10.1111/crj.13031

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T2 - Clinical Respiratory Journal

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SN - 1752-6981

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