Bronchoscopic lung volume reduction: indications, effects and prospects.

PURPOSE OF REVIEW: Despite optimal pharmacological treatment, many patients with chronic obstructive pulmonary disease remain very disabled. Bronchoscopic lung volume reduction involves the insertion of valves into the airways supplying emphysematous areas of lung with the intention of causing atelectasis and thus improving operating lung volumes. Bronchoscopic techniques are less hazardous than lung volume reduction surgery.

RECENT FINDINGS: Case series in the literature are reviewed. The presence of extensive pathological collateral ventilation, particularly in patients with homogeneous disease, means that atelectasis occurs relatively infrequently even with complete lobar occlusion. Benefit is greatest in the presence of atelectasis but does not occur only in this group of patients. Endobronchial valves have also been used to treat persistent air leaks in a number of clinical contexts.

SUMMARY: A number of case series have been published which show promise and the results of a large multicentre randomized controlled study are anticipated in 2007. A number of other bronchoscopic treatments for emphysema are also under development, including airway bypass techniques and tissue glues.