Affiliation:
1. Department of Thoracic Medicine Royal Adelaide Hospital Adelaide South Australia Australia
2. Faculty of Health and Medical Sciences, Adelaide Medical School University of Adelaide Adelaide South Australia Australia
3. Department of Respiratory and Sleep Medicine Queen Elizabeth Hospital Adelaide South Australia Australia
4. Department of Nuclear Medicine Royal Adelaide Hospital Adelaide South Australia Australia
5. SA Medical Imaging Royal Adelaide Hospital Adelaide South Australia Australia
Abstract
AbstractBackgroundEndobronchial valve (EBV) insertion for lung volume reduction is a management option for patients with severe emphysema. One‐way valves cause lobar deflation and improve lung function, exercise capacity and quality of life.AimsTo retrospectively analyse and compare the outcomes of the first 57 patients treated with EBVs between 2015 and 2021 at the Royal Adelaide Hospital to international standards.MethodsClinical outcomes of forced expiratory volume in 1 s (FEV1), residual volume (RV), treated lobe volume reduction (TLVR) and 6‐min walk distance (6MWD) at 3, 6 and 12 months after valve insertion were reviewed against established minimally clinically important differences (MCIDs). Complications and subjective breathlessness measured by Borg scores were also reviewed.ResultsFifty‐seven patients were included. At 12 months, 77.2% achieved TLVR. FEV1 improved by 170 mL (95% confidence interval (CI): 100–250, P < 0.001), 80 mL (95% CI: 10–150, P = 0.019) and 40 mL (95% CI: −60 to 130, P 0.66) at 3, 6 and 12 months respectively. RV improved by −610 mL (95% CI: −330 to −900, P < 0.0001) at 3 months, −640 mL (95% CI: −360 to −920, P < 0.0001) at 6 months and −360 mL (95% CI: −60 to −680, P = 0.017) at 12 months. 6MWD improved by 57.34 m (95% CI: 36.23–78.45, P < 0.0001) and 44.93 m (95% CI: 7.19–82.67, P = 0.02) at 3 and 6 months. Borg score improved by −0.53 (95% CI: 0.11 to −1.2, P = 0.11) and −0.49 (95% CI: 0.17 to −1.15, P = 0.16) at 3 and 6 months. Complication rates aligned with international standards with mucous/infection (26.3%) and pneumothorax (17.5%) as the most common. Subgroup analysis signalled improved outcomes in patients with heterogeneous emphysema.ConclusionOur study represents the first publicly funded Australian analysis of EBVs. The results align with international prospective trials demonstrating improved lung function and exercise capacity. Australians with severe emphysema and gas trapping should be referred to a multidisciplinary centre for consideration of EBVs.