The patients selected for bronchoscopic lung volume reduction were younger compared with those who were not, the investigators said.
Though it was linked to a significant survival benefit, there remains a need for better tools to help refer patients with chronic obstructive pulmonary disease (COPD) for bronchoscopic lung volume reduction (BLVR), according to a paper published in the International Journal of Chronic Obstructive Pulmonary Disease.
Investigators from the Netherlands conducted a retrospective analysis of 1500 patients with severe COPD in order to determine the differences between patients selected for BLVR and those who were not. The study authors said only limited knowledge exists about the characteristics and outcomes for patients who are referred to a specialized center for BLVR. Alternatives for BLVR treatment include lung volume reduction surgery or lung transplantation, but both procedures are very invasive and limited by scarce availability and strict selection procedures, the study authors explained.
They noted their patients’ demographics, comorbidity, chest computed tomography characteristics, reasons for rejection from BLVR treatment, and patient survival.
Half of the patients were female and the mean age was 62 years, the study authors noted. Of the 1500 patients, only 651 were invited to a consultation at the study authors’ facility. Of that group, 282 (19%) were selected for clinical trial or the regular treatment program. The study authors said the remaining 1218 patients were not considered eligible for BLVR.
The study authors noted that the patients were selected for different bronchoscopic treatments: 175 patients were selected for endobronchial valves (EBV), 93 patients for lung volume reduction coils (LVRC), 3 patients for airway bypass stents, 9 patients for polymeric lung volume reduction, and 2 patients for pnuemostoma.
The patients selected for BLVR were younger compared to those who were not, the investigators said (59 years vs. 63 years). They also had a lower forced expiratory volume in 1 second (FEV1, 28% vs. 34% of predicted), and a higher residual volume (237% vs. 215% of predicted), the authors determined.
There were a handful of reasons the study authors encountered for patients being ineligible for BLVR, they said: absence of a suitable target lobe for treatment (18%); unsuitable disease phenotype for treatment, such as having chronic bronchitis, frequent exacerbations, or asthma (18%); and insufficient hyperinflation of the lungs (16%).
The patients selected for BLVR had significantly fewer comorbidities compared with those referred but were unsuitable for treatment (1.1 vs. 1.4, respectively). The most common comorbidities among the patients unable to receive BLVR treatment were: hypertension (22%); confirmed or suspected asthma (18%); and coronary artery disease (10%), the authors found.
The researchers said 85% of their patients’ survival status could not be verified, but that the overall median survival was 2316 days. For patients referred to the authors’ hospital but not invited for consultation, there was a median survival of 1808 days. Patients invited for consultation but that did not receive BLVR treatment had a median survival of 2524 days. And finally, patients that received BLVR treatment lived longer than those who did not get the treatment: 3060 days vs. 2079 days (P < .001), respectively, the authors found.
“Only a small proportion of the already preselected group of patients that were considered to be eligible for BLVR by the referring physician is selected for BLVR treatment,” the authors wrote. “This highlights both the need for improved referral strategies on the one hand and the important need for additional therapeutic options for patients with severe COPD on the other hand.”
Because only a small proportion of patients referred for BLVR treatment is eligible for the treatment, the authors said their findings indicate a need for development of new therapies for this group as well as better referral tools.
Welling JBA, Hartman JE, Augustijn SWS, et al. Patient selection for bronchoscopic lung volume reduction. Int J Chron Obstruct Pulmon Dis. 2020;15:871-881. doi: 10.2147/COPD.S240848.