Bronchoscopic Lung Volume Reduction in COPD: Current Evidence and Future Directions
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Abstract
Bronchoscopic lung volume reduction has emerged as a promising intervention for patients with chronic obstructive pulmonary disease who remain symptomatic despite optimal medical management. This literature review evaluates the efficacy, safety, and patient selection criteria for bronchoscopic lung volume reduction, focusing on its role in improving lung function, exercise capacity, and quality of life. Techniques such as endobronchial valves, coils, and bronchoscopic thermal vapor ablation offer less invasive alternatives to surgical lung volume reduction by targeting diseased lung regions to reduce hyperinflation. Key clinical trials, including VENT, LIBERATE, and EMPROVE, indicate that bronchoscopic lung volume reduction can provide significant benefits for carefully selected patients, particularly those with heterogeneous emphysema and low collateral ventilation. The VENT trial demonstrated notable improvements in lung function and quality of life, while the LIBERATE trial highlighted the efficacy of endobronchial valves in reducing lung volume and improving exercise capacity. However, the procedure is associated with risks, including pneumothorax, exacerbations, and respiratory infections. Optimal patient selection is crucial, with the greatest benefits observed in patients with upper-lobe predominant emphysema and significant hyperinflation. Pre-procedural evaluation includes high-resolution computed tomography and functional imaging to assess emphysema distribution, identify target lobes, and detect the presence of collateral ventilation. Despite the advantages, long-term efficacy and safety profile require further investigation through larger and more diverse patient populations. This review addresses the clinical implications, emphasizing a multidisciplinary approach to patient selection and management. Future research should focus on refining patient selection criteria, improving procedural techniques, and assessing long-term outcomes to establish standardized protocols and confirm the sustained benefits of bronchoscopic lung volume reduction. Additionally, completing fissures with thoracoscopic surgery to broaden the applicability of bronchoscopic lung volume reduction is an emerging area of research.
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