Atelectasis boosts post-BLVR survival in COPD patients
MedWire News: Patients who experience atelectasis following bronchoscopic lung volume reduction (BLVR) for chronic obstructive pulmonary disease (COPD) appear to have a survival benefit over those who do not, conclude UK researchers.
Despite optimal pharmacological therapy and pulmonary rehabilitation, COPD patients may have significant disabilities. Lung volume reduction surgery has been shown to improve outcomes, but the procedure is associated with significant morbidity and is not appropriate in all patients, explain Nicholas Hopkinson (Royal Brompton Hospital, London) and colleagues.
Noting that BLVR using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in emphysema patients, theteam examined medical records for 19 patients with a mean FEV1 of 28.4% who underwent BLVR between 2002 and 2004. Survival data were available for all patients to 2010.
Five patients had radiological atelectasis. None of these patients died during follow-up, compared with eight of the 14 patients who did not develop atelectasis. Furthermore, atelectasis was an independent predictor of survival at 6 years on stepwise regression analysis.
There were no significant differences between patients with and without atelectasis in baseline spirometry, lung volumes, gas transfer, blood gas parameters, quality of life, number of exacerbations in the preceding year, or exercise capacity. Body mass index was significantly higher in the atelectasis group compared with the non-atelectasis group.
The researchers report in the European Respiratory Journal that there were no significant lung differences at baseline on computed tomography between the atelectasis and non-atelectasis groups. Following BLVR, 22% of patients who improved and 60% of the non-improvers had died by 6 years. Again, atelectasis was the only significant difference between survivors and non-survivors.
The team concludes: "These data suggest that where BLVR is successful in producing atelectasis, this imparts a significant survival advantage. The data also illustrate that longer term follow-up is needed to evaluate fully the risks and benefits of bronchoscopic lung volume procedures."
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By Liam Davenport