HHE Respiratory 2019 | Page 3

RESPIRATORY Endoscopic lung volume reduction in COPD In recent years, minimally invasive endoscopic lung volume reduction methods have become an important option in the treatment of COPD patients with an emphysema phenotype Aşkın Gülşen MD PhD Department of Pneumology, University of Lübeck, Germany Ayşe Pelin Girgin MD Department of Anesthesiology, Cigli Education and Research Hospital, Izmir, Turkey Chronic obstructive pulmonary disease (COPD) is a disease characterised by chronic airflow limitation, and progressive and persistent respiratory symptoms. 1 Today, COPD is the third largest cause of mortality worldwide, and its incidence increases gradually with smoking status. 2 Emphysema is one of the subtypes of COPD, and its treatment with standard drugs is often difficult because of alveolar tissue damage, loss of elastic recoil, air trapping and hyperinflation. 3 Pulmonary function tests in emphysema patients show increases in total lung capacity (TLC) and residual volume (RV) in addition to the classical COPD findings. Standard treatment regimens for COPD normally include smoking cessation, inhaler therapy, breathing exercises, nutritional support, as well as oxygen 3 HHE 2019 | hospitalhealthcare.com therapy and non-invasive ventilation in patients with severe emphysema. 1 Unfortunately, these treatments do not always yield satisfactory results in patients with severe emphysema. In such patients, hyperinflation, local air trapping and intrathoracic compression are notable problems that result in increased breathing difficulty and place an additional burden on the respiratory muscles. There are, however, other treatment options for patients with severe emphysema, such as lung volume reduction surgery, bullectomy and lung transplantation. 4 Surgery is only suitable for selected patients due to intraoperative risks, postoperative complications, and increased mortality. 5 In the last decade, endoscopic methods providing similar results to those of lung