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Bronchoscopic treatment of severe pulmonary emphysema with unidirectional valves: evaluation of parameters for clinical and functional outcomes

Abstract

Advanced pulmonary emphysema results in severe hyperinflation that limits expiratory flows, diaphragmatic excursion and exercise capacity thus causing dyspnea with an impact in the quality of life. Current therapy includes medical management, pulmonary rehabilitation, bulectomy, lung volume reduction surgery and lung transplantation with considerable morbidity and mortality. One-way valves placed bronchoscopically have become an alternative approach for achieving lung volume reduction in selected cases of heterogeneous emphysema. Clinical studies have shown that the procedure is safe and effective, however the elgibility criteria for the procedure and assessment need refinements. Presently, there have been new methods for quantifying emphysema, lung hyperinflation, deflation and parameters of clinical and functional response. Novel methods such as CT scan lung volumetry, dynamic lung volumetry by electrical impedance tomography and diaphragmatic mobility by ultrasound are amongst the recent advances that have not yet been studied. This study focuses on an evaluation of both the physiological and functional parameters of clinical response after valve placement using such new methods. The outcomes assessed are: redistribution of ventilation on electrical impedance tomography; measurable volume reduction on CT scan volumetry; increase in diaphragmatic mobility by ultrasound; a 5% increase in post-bronchodilator FEV1; increase in inspiratory capacity; increase in quality of life and improvement in the dyspnea score. Ten patients with heterogeneous emphysema that meet the elegibility criteria will be enrolled and submitted to a rehabilitation program, chest CT scans, followed by full body phletismography, 6-minute walk test, electrical impedance tomography, electronic optophletismography, evaluation of diaphragmatic mobility by ultrasound, quality of life and dyspnea questionnaires. Upon completion of the pre-treatment assessment, the patients will be submitted to bronchoscopy and placement of 1 to 3 endobronchial valves preferably in the upper lobes. After the procedure the patients will be reassessed in regular intervals for 6 months using the same methods. Post-procedure assessment parameters will be compared to pre-treatment thus enabling a more accurate evaluation of the clinical response, as well as functional and imaging parameters. (AU)

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