ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Bronchoscopic Lung Volume Reduction in an 82 Year Old Male with Emphysema
Session Title
TP38 - TP038 INTERESTING AND CHALLENGING CASES IN INTERVENTIONAL PULMONOLOGY
Abstract
A2191 - Bronchoscopic Lung Volume Reduction in an 82 Year Old Male with Emphysema
Author Block: J. E. Munoz1, C. Tharumia Jagadeesan2, A. J. Vaccarello1, A. Khokar3, A. I. Saeed4; 1Internal Medicine, Creighton University School of Medicine - Phoenix Internal Medicine Program, Phoenix, AZ, United States, 2Internal Medicine, St.Joseph's Hospital and Medical Center, Phoenix, AZ, United States, 3Interventional Pulmonary, Norton Thoracic Institute, phoenix, AZ, United States, 4Interventional Pulmonary, Norton Thoracic Institute, Phoenix, AZ, United States.
Introduction:Bronchoscopic lung volume reduction (LVR) is a minimally invasive treatment for patients with advanced emphysema on maximal medical management. Bronchoscopic lung volume reduction surgery (BLVRS) refers to segmental atelectasis with endobronchial valves (EBV) to treat emphysematous hyperinflation via a flexible bronchoscope. Several inclusion and exclusion criteria exist for this procedure, without a clear age limit defined. We present the case of an 82 year old male who successfully underwent EBV placement for severe RUL emphysema.
Presentation:An 82 year old male with a PMH of COPD with emphysema presented for BLVRS evaluation for chronic SOB and exercise intolerance. At baseline, he required 2L of O2. His mMRC score was > 2. The patient had a 40 pack year smoking history, though quit 35 years ago. Recent PFTs showed FEV1 24%, RV 234%, TLC 113%. His 6 minute walk results were 354m on 2L O2. A high resolution CT scan confirmed upper lobe predominant emphysematous damage. He met criteria for BLVRS and elected to proceed with the procedure. The patient underwent bronchoscopy with placement of 3 EBVs in the apical, anterior, and posterior segments of the RUL. CXR the following morning revealed RUL atelectasis as expected without pneumothorax. The patient was successfully discharged 72 hours post procedure with close follow up.
Discussion:One-way EBVs are designed to facilitate atelectasis of the damaged, hyperinflated lung after confirmation of fissural integrity with balloon occlusion bronchoscopy. Consequently, we expect to see improvement in SOB and increased exercise tolerance. Proposed mechanisms include decreased air trapping and bronchoconstriction, improved elastic lung recoil, and improved diaphragm movement. Currently, patients considered for BLVRS have been evaluated under inclusion and exclusion criteria similar to those of the National Emphysema Treatment Trial (NETT). During that trial, the upper age limit used was 75. In our patient, all NETT criteria were met except for age. Our patient tolerated the procedure well, and though it is early to assess final outcomes, we propose that BVLRS should not be disregarded on age alone. More research must be dedicated to the use of BLVRS with the goal of improving dyspnea and exercise tolerance.
References:1. Gülşen A. Bronchoscopic Lung Volume Reduction: A 2018 Review and Update. Turk Thorac J. 2018;19(3):141-149. doi:10.5152/TurkThoracJ.2018.18044. 2. Ingenito EP, Wood DE, Utz JP. Bronchoscopic lung volume reduction in severe emphysema. Proc AM Thorac Soc 2008; 5:454. 3. Herth FJ, Gompelmann D, Ernst A, Eberhardt R. Endoscopic lung volume reduction. Respiration 2010; 79:5
Author Block: J. E. Munoz1, C. Tharumia Jagadeesan2, A. J. Vaccarello1, A. Khokar3, A. I. Saeed4; 1Internal Medicine, Creighton University School of Medicine - Phoenix Internal Medicine Program, Phoenix, AZ, United States, 2Internal Medicine, St.Joseph's Hospital and Medical Center, Phoenix, AZ, United States, 3Interventional Pulmonary, Norton Thoracic Institute, phoenix, AZ, United States, 4Interventional Pulmonary, Norton Thoracic Institute, Phoenix, AZ, United States.
Introduction:Bronchoscopic lung volume reduction (LVR) is a minimally invasive treatment for patients with advanced emphysema on maximal medical management. Bronchoscopic lung volume reduction surgery (BLVRS) refers to segmental atelectasis with endobronchial valves (EBV) to treat emphysematous hyperinflation via a flexible bronchoscope. Several inclusion and exclusion criteria exist for this procedure, without a clear age limit defined. We present the case of an 82 year old male who successfully underwent EBV placement for severe RUL emphysema.
Presentation:An 82 year old male with a PMH of COPD with emphysema presented for BLVRS evaluation for chronic SOB and exercise intolerance. At baseline, he required 2L of O2. His mMRC score was > 2. The patient had a 40 pack year smoking history, though quit 35 years ago. Recent PFTs showed FEV1 24%, RV 234%, TLC 113%. His 6 minute walk results were 354m on 2L O2. A high resolution CT scan confirmed upper lobe predominant emphysematous damage. He met criteria for BLVRS and elected to proceed with the procedure. The patient underwent bronchoscopy with placement of 3 EBVs in the apical, anterior, and posterior segments of the RUL. CXR the following morning revealed RUL atelectasis as expected without pneumothorax. The patient was successfully discharged 72 hours post procedure with close follow up.
Discussion:One-way EBVs are designed to facilitate atelectasis of the damaged, hyperinflated lung after confirmation of fissural integrity with balloon occlusion bronchoscopy. Consequently, we expect to see improvement in SOB and increased exercise tolerance. Proposed mechanisms include decreased air trapping and bronchoconstriction, improved elastic lung recoil, and improved diaphragm movement. Currently, patients considered for BLVRS have been evaluated under inclusion and exclusion criteria similar to those of the National Emphysema Treatment Trial (NETT). During that trial, the upper age limit used was 75. In our patient, all NETT criteria were met except for age. Our patient tolerated the procedure well, and though it is early to assess final outcomes, we propose that BVLRS should not be disregarded on age alone. More research must be dedicated to the use of BLVRS with the goal of improving dyspnea and exercise tolerance.
References:1. Gülşen A. Bronchoscopic Lung Volume Reduction: A 2018 Review and Update. Turk Thorac J. 2018;19(3):141-149. doi:10.5152/TurkThoracJ.2018.18044. 2. Ingenito EP, Wood DE, Utz JP. Bronchoscopic lung volume reduction in severe emphysema. Proc AM Thorac Soc 2008; 5:454. 3. Herth FJ, Gompelmann D, Ernst A, Eberhardt R. Endoscopic lung volume reduction. Respiration 2010; 79:5
