A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort
Background Endobronchial 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. Aims To retrospectively analyse and compare the outcomes of the f...
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| Veröffentlicht in: | Internal medicine journal 2024-06, Vol.54 (6), p.871-881 |
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| creator | Brown, Michael V. Badiei, Arash Jersmann, Hubertus Fon, Andrew Chew, Chong G. Lorraine, Brett Nguyen, Phan |
| description | Background
Endobronchial 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.
Aims
To 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.
Methods
Clinical 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.
Results
Fifty‐seven patients were included. At 12 months, 77.2% achieved TLVR. FEV1 improved by 170 mL (95% confidence interval (CI): 100–250, P |
| doi_str_mv | 10.1111/imj.16319 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2917554608</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2917554608</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3489-8885b07a9e8a427ad3142ffaebd17989344b26fe255655f33ce02adca1c02eee3</originalsourceid><addsrcrecordid>eNp10buOEzEUBmALgdgQKHiBlSUaKCbr64xdRisuQYtooKGxPJ4zG0czdmJnAul4BJ6RJ8EkyxYr4cZH1qdf1vkReknJgpZz5cfNgtac6kdoRoWQldRaPD7NoiKa8Av0LOcNIbThWjxFF1wx0QjCZmi3xPXvn7-OYBOGH1tIHoIDHHv8DbbrY3kMXWxTDG7t7YAPdjhAxn1MOMMBEmAYC8swWuwDtgEvp7xPdvBlzD7cDlDSHYR9oS6uY9o_R096O2R4cXfP0dd3b79cf6huPr9fXS9vKseF0pVSSraksRqUFayxHaeC9b2FtqONVpoL0bK6ByZlLWXPuQPCbOcsdYQBAJ-j1-fcbYq7CfLejD47GAYbIE7ZME0bKUVNVKGvHtBNnFIovzOc1KohhGhe1JuzcinmnKA32-RHm46GEvO3B1N6MKceir28S5zaEbp7-W_xBVydwXc_wPH_SWb16eM58g_cspQ-</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3068700093</pqid></control><display><type>article</type><title>A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Brown, Michael V. ; Badiei, Arash ; Jersmann, Hubertus ; Fon, Andrew ; Chew, Chong G. ; Lorraine, Brett ; Nguyen, Phan</creator><creatorcontrib>Brown, Michael V. ; Badiei, Arash ; Jersmann, Hubertus ; Fon, Andrew ; Chew, Chong G. ; Lorraine, Brett ; Nguyen, Phan</creatorcontrib><description>Background
Endobronchial 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.
Aims
To 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.
Methods
Clinical 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.
Results
Fifty‐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.
Conclusion
Our 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.</description><identifier>ISSN: 1444-0903</identifier><identifier>EISSN: 1445-5994</identifier><identifier>DOI: 10.1111/imj.16319</identifier><identifier>PMID: 38247402</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>bronchoscopy ; Clinical trials ; Emphysema ; endobronchial valve ; International standards ; lung volume reduction ; Patients ; Pneumothorax ; Quality of life ; Respiratory function ; smoking</subject><ispartof>Internal medicine journal, 2024-06, Vol.54 (6), p.871-881</ispartof><rights>2024 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.</rights><rights>2024 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3489-8885b07a9e8a427ad3142ffaebd17989344b26fe255655f33ce02adca1c02eee3</cites><orcidid>0000-0002-6678-1407</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fimj.16319$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fimj.16319$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38247402$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brown, Michael V.</creatorcontrib><creatorcontrib>Badiei, Arash</creatorcontrib><creatorcontrib>Jersmann, Hubertus</creatorcontrib><creatorcontrib>Fon, Andrew</creatorcontrib><creatorcontrib>Chew, Chong G.</creatorcontrib><creatorcontrib>Lorraine, Brett</creatorcontrib><creatorcontrib>Nguyen, Phan</creatorcontrib><title>A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort</title><title>Internal medicine journal</title><addtitle>Intern Med J</addtitle><description>Background
Endobronchial 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.
Aims
To 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.
Methods
Clinical 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.
Results
Fifty‐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.
Conclusion
Our 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.</description><subject>bronchoscopy</subject><subject>Clinical trials</subject><subject>Emphysema</subject><subject>endobronchial valve</subject><subject>International standards</subject><subject>lung volume reduction</subject><subject>Patients</subject><subject>Pneumothorax</subject><subject>Quality of life</subject><subject>Respiratory function</subject><subject>smoking</subject><issn>1444-0903</issn><issn>1445-5994</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp10buOEzEUBmALgdgQKHiBlSUaKCbr64xdRisuQYtooKGxPJ4zG0czdmJnAul4BJ6RJ8EkyxYr4cZH1qdf1vkReknJgpZz5cfNgtac6kdoRoWQldRaPD7NoiKa8Av0LOcNIbThWjxFF1wx0QjCZmi3xPXvn7-OYBOGH1tIHoIDHHv8DbbrY3kMXWxTDG7t7YAPdjhAxn1MOMMBEmAYC8swWuwDtgEvp7xPdvBlzD7cDlDSHYR9oS6uY9o_R096O2R4cXfP0dd3b79cf6huPr9fXS9vKseF0pVSSraksRqUFayxHaeC9b2FtqONVpoL0bK6ByZlLWXPuQPCbOcsdYQBAJ-j1-fcbYq7CfLejD47GAYbIE7ZME0bKUVNVKGvHtBNnFIovzOc1KohhGhe1JuzcinmnKA32-RHm46GEvO3B1N6MKceir28S5zaEbp7-W_xBVydwXc_wPH_SWb16eM58g_cspQ-</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Brown, Michael V.</creator><creator>Badiei, Arash</creator><creator>Jersmann, Hubertus</creator><creator>Fon, Andrew</creator><creator>Chew, Chong G.</creator><creator>Lorraine, Brett</creator><creator>Nguyen, Phan</creator><general>John Wiley & Sons Australia, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6678-1407</orcidid></search><sort><creationdate>202406</creationdate><title>A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort</title><author>Brown, Michael V. ; Badiei, Arash ; Jersmann, Hubertus ; Fon, Andrew ; Chew, Chong G. ; Lorraine, Brett ; Nguyen, Phan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3489-8885b07a9e8a427ad3142ffaebd17989344b26fe255655f33ce02adca1c02eee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>bronchoscopy</topic><topic>Clinical trials</topic><topic>Emphysema</topic><topic>endobronchial valve</topic><topic>International standards</topic><topic>lung volume reduction</topic><topic>Patients</topic><topic>Pneumothorax</topic><topic>Quality of life</topic><topic>Respiratory function</topic><topic>smoking</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Michael V.</creatorcontrib><creatorcontrib>Badiei, Arash</creatorcontrib><creatorcontrib>Jersmann, Hubertus</creatorcontrib><creatorcontrib>Fon, Andrew</creatorcontrib><creatorcontrib>Chew, Chong G.</creatorcontrib><creatorcontrib>Lorraine, Brett</creatorcontrib><creatorcontrib>Nguyen, Phan</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Internal medicine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Michael V.</au><au>Badiei, Arash</au><au>Jersmann, Hubertus</au><au>Fon, Andrew</au><au>Chew, Chong G.</au><au>Lorraine, Brett</au><au>Nguyen, Phan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort</atitle><jtitle>Internal medicine journal</jtitle><addtitle>Intern Med J</addtitle><date>2024-06</date><risdate>2024</risdate><volume>54</volume><issue>6</issue><spage>871</spage><epage>881</epage><pages>871-881</pages><issn>1444-0903</issn><eissn>1445-5994</eissn><abstract>Background
Endobronchial 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.
Aims
To 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.
Methods
Clinical 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.
Results
Fifty‐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.
Conclusion
Our 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.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>38247402</pmid><doi>10.1111/imj.16319</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6678-1407</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | bronchoscopy Clinical trials Emphysema endobronchial valve International standards lung volume reduction Patients Pneumothorax Quality of life Respiratory function smoking |
| title | A 6‐year experience of Zephyr endobronchial valves for severe emphysema in an Australian single‐centre cohort |
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