HHE Respiratory 2019 - Page 6

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 References: 1 Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2017. www.goldcopd. org/ (accessed July 2019). 2 Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med 2013;369:448–57. 3 Holloway RA, Donnelly LE. Immunopathogenesis of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2013;19:95–102 4 Marchetti N, Criner GJ. Surgical approaches to treating emphysema: Lung volume reduction surgery, bullectomy, and lung transplantation. Semin Respir Crit Care Med 2015;36: 592–608. 5 Criner GJ et al. The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med 2011;184:881–93. 6 Gülşen A. Bronchoscopic lung volume reduction: A 2018 review and update. Turk Thorac J 2018;19:141–9. 7 Herth FJF et al. Endoscopic lung volume reduction: An expert panel recommendation – Update 2019. Respiration 2019;97(6):548–57. 8 Slebos DJ et al. Endobronchial valves for endoscopic lung volume reduction: Best practice recommendations from Expert Panel on Endoscopic Lung Volume Reduction. Respiration 2017;93:138–50. 9 Gordon M, Duffy S, Criner GJ. Lung volume reduction surgery or bronchoscopic lung volume reduction: is there an algorithm for allocation? J Thorac Dis 2018;10:2816–23. 10 Gulsen A et al. Evaluation of bronchoscopic lung volume reduction coil treatment results in patients with severe emphysema. Clin Respir J 2017;11:585–92. 11 Welling JBA et al. Minimal important difference of target lobar volume reduction after endobronchial valve treatment for emphysema. Respirology 2018;23:306–10. 12 Slebos DJ et al. Endobronchial coils for endoscopic lung volume reduction: Best practice recommendations from an Expert Panel. Respiration 2018;96:1–11. 13 Bostancı K et al. Endobronchial coils in treatment of advanced emphysema: A single center experience. Turk Gogus Kalp Dama 2019;27: 57–62. 14 Gülsen A. Effects of bronchoscopic lung volume reduction coil treatment on arterial blood gases. J Bronchology Interv Pulmonol 2019;26(2):90–5. 15 Fiorelli A et al. Complications related to endoscopic lung volume reduction for emphysema with endobronchial valves: results of a multicenter study. J Thorac Dis 2018;10:3315–25. 6 HHE 2019 | hospitalhealthcare.com 16 Gompelmann D et al. Clinical and radiological outcome following pneumothorax after endoscopic lung volume reduction with valves. Int J Chron Obstruct Pulmon Dis 2016;11:3093–9. 17 Herth FJ et al. Assessment of a novel lung sealant for performing endoscopic volume reduction therapy in patients with advanced emphysema. Expert Rev Med Devices 2011;8:307–12. 18 Metin B et al. A single- center comparison of the cost analyses of different volume reduction-therapy methods in the treatment of emphysema. Cukurova Med J 2017;42:721–79. 19 Deslée G et al; REVOLENS Study Group. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: The REVOLENS Randomized Clinical Trial. JAMA 2016;315:175–84. 20 Gulsen A. Importance of bronchoscopic lung volume reduction coil therapy in potential candidates for lung transplantation. Biosci Trends 2018;12:395–402. 21 Bakeer M et al. Low cost biological lung volume reduction therapy for advanced emphysema. Int J Chron Obstruct Pulmon Dis 2016;11:1793–800. 22 Hu Y et al. A new-designed lung-bending device for bronchoscopic lung volume reduction of severe emphysema: A feasibility study in pigs. Respiration 2019;97(5):444–50