able to undergo the procedure, it is sometimes
necessary to postpone it because a patient might
not be able to tolerate the stress of anaesthesia. 10
Cost-effectiveness
ELVR treatment methods are expensive. Cost
estimates following an analysis were: valve method
($12,943); coil method ($11,328); and volume
reduction surgery ($2444). 18 These calculations do
not include the costs associated with the
management of complications and hospitalisation.
Depending on agreements with health care systems,
the cost of the Chartis catheter and delivery system
for a single procedure can vary from $9185 to
$10,300. However, total costs for one year of coil
treatments were approximately $53,521 and $5912
for follow-up patients. 19 In a landmark study
(REVOLENS), the initial cost of coil therapy seemed
very high, therefore, large-scale studies are required
to better determine this method’s long-term cost
and efficacy. 19
Conclusions
Increasing ELVR treatment modalities have
expanded the treatment spectrum for COPD
patients with severe emphysema. In a group of
patients with severe COPD, who were potential
lung transplant candidates, positive results were
obtained with ELVR treatment, indicating that
ELVR treatment can act as a bridge until the time
of transplantation. 20 The most important reason
for increasing treatment efficacy is correct patient
selection. Although the EBV and coil treatments
are the most commonly used methods, there is
emerging positive evidence for other methods,
such as thermal vapour ablation, bio-lung volume
reduction, and targeted lung denervation.
Autologous blood application will be performed
much more frequently in the near future due to
its low cost and easy applicability. 21 Most recently,
a newly designed device known as the ‘reverser’,
which is similar to the coil structure, was tested
in pigs, and positive results were obtained. 22 The
creation of treatment algorithms, research on the
long-term effects of these methods, prevention
and control of complications, and appropriate
development of these methods are the most
important issues ahead.
follow-up. However, prophylactic antibiotics are
frequently used by the bronchoscopist due to the
high risk of COPD exacerbation and pneumonia.
There is no general consensus on the best
application of prophylactic antibiotics. Short-term
steroid administration and stress ulcer
prophylaxis are generally recommended to reduce
the post-treatment acute inflammatory response. 17
Use of anaesthesia during the procedure
The EBV procedure is generally performed with
mild sedation, and the coil procedure is
performed with general anaesthesia in the
operating room. Although patients are generally
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