Endobronchial coils for emphysema: Dual mechanism of action on lobar residual volume reduction

Jorine E Hartman, Pallav L Shah, Frank Sciurba, Felix J F Herth, Dirk-Jan Slebos, RENEW Study Group, F J F Herth, D Gompelmann, M Schuhmann, R Eberhardt, D Harzheim, B Rump, D J Slebos, N Ten Hacken, K Klooster, J E Hartman, S Augustijn, P L Shah, C Caneja, W McNulty, J Garner, G Deslée, H Vallerand, S Dury, D Gras, M Verdier, C H Marquette, C Sanfiorenzo, C Clary, C Leheron, J Pradelli, S Korzeniewski, P Wolter, T Arfi, F Macone, M Poudenx, S Leroy, A Guillemart, J Griffonet, C Strange, R Argula, G Silvestri, J T Huggins, N Pastis, D Woodford, L Schwarz, D Walker, G Criner, J Mamary, N Marchetti, P Desai, K Shenoy, J L Garfield, J Travaline, H Criner, S Srivastava-Malhotra, V Tauch, R Maxfield, K Brenner, W Bulman, B A Whippo, P A Jellen, R Kalhan, C T Gillespie, S Rosenberg, M McAvoy DeCamp, A S Rogowski, J Hixon, L F Angel, O Dib, F C Sciurba, D Chandra, M Crespo, J Bon Field, J Rahul Tedrow, C Ledezma, P Consolaro, M Beckner, A Majid, G Cheng, J Cardenas-Garcia, D Beach, E Folch, A Agnew, W Hori, A Nathanson, M Wahidi, S Shofer, M Hartwig, K Mahmood, E Smathers, W Tillis, K Verma, D Taneja, M Peil, S Chittivelu, P Doloszycki, P E Whitten, B Aulakh, O Ikadios, J Michel, J Crabb, B McVay, A Scott, E A Pautler, T A Connolly, J F Santacruz, L Kopas, R Parham, B Solid, W Krimsky, F Gregoire, S King, A Mehta, F Almeida, T Gildea, J Cicenia, M Machuzak, S Sethi, Y M Meli, J Baran, R Rice, D Faile, N Rai, K Jensen, R Kahlstrom, A Haroon, R Ionita, F White, D Watkins, B Moore, H Soukiasian, H Merry, Z Mosenifar, S Ghandehari, D Balfe, J Park, R Mardirosian, J S Ferguson, J Kanne, D Sonetti, D Modi, M Regan, J Maloney, M Hackbarth, M Gilles, A Harris, A Maser, J T Puchalski, C Rochester, J Possick, K Johnson, Z Dabre, K Kovitz, M Joo, J DeLisa, S V Villalan, G Krishna, J Canfield, A Marfatia, E Selley, S V Villalan, J Utz, D Midthun, R Kern, E S Edell, L L Boras, S Gay, K A Bauman, M King Han, R L Sagana, K Nelson, C Meldrum, M Jantz, H J Mehta, C Eagan, J West, A Delage, S Martel, P LeBlanc, F Maltais, Y Lacasse, N Lampron, F Laberge, J Milot, J Picard, M J Breton, M Dransfield, J M Wells, S Bhatt, P Smith, E N Seabron-Harris, K Hammond, C Egidio, Jorine E Hartman, Pallav L Shah, Frank Sciurba, Felix J F Herth, Dirk-Jan Slebos, RENEW Study Group, F J F Herth, D Gompelmann, M Schuhmann, R Eberhardt, D Harzheim, B Rump, D J Slebos, N Ten Hacken, K Klooster, J E Hartman, S Augustijn, P L Shah, C Caneja, W McNulty, J Garner, G Deslée, H Vallerand, S Dury, D Gras, M Verdier, C H Marquette, C Sanfiorenzo, C Clary, C Leheron, J Pradelli, S Korzeniewski, P Wolter, T Arfi, F Macone, M Poudenx, S Leroy, A Guillemart, J Griffonet, C Strange, R Argula, G Silvestri, J T Huggins, N Pastis, D Woodford, L Schwarz, D Walker, G Criner, J Mamary, N Marchetti, P Desai, K Shenoy, J L Garfield, J Travaline, H Criner, S Srivastava-Malhotra, V Tauch, R Maxfield, K Brenner, W Bulman, B A Whippo, P A Jellen, R Kalhan, C T Gillespie, S Rosenberg, M McAvoy DeCamp, A S Rogowski, J Hixon, L F Angel, O Dib, F C Sciurba, D Chandra, M Crespo, J Bon Field, J Rahul Tedrow, C Ledezma, P Consolaro, M Beckner, A Majid, G Cheng, J Cardenas-Garcia, D Beach, E Folch, A Agnew, W Hori, A Nathanson, M Wahidi, S Shofer, M Hartwig, K Mahmood, E Smathers, W Tillis, K Verma, D Taneja, M Peil, S Chittivelu, P Doloszycki, P E Whitten, B Aulakh, O Ikadios, J Michel, J Crabb, B McVay, A Scott, E A Pautler, T A Connolly, J F Santacruz, L Kopas, R Parham, B Solid, W Krimsky, F Gregoire, S King, A Mehta, F Almeida, T Gildea, J Cicenia, M Machuzak, S Sethi, Y M Meli, J Baran, R Rice, D Faile, N Rai, K Jensen, R Kahlstrom, A Haroon, R Ionita, F White, D Watkins, B Moore, H Soukiasian, H Merry, Z Mosenifar, S Ghandehari, D Balfe, J Park, R Mardirosian, J S Ferguson, J Kanne, D Sonetti, D Modi, M Regan, J Maloney, M Hackbarth, M Gilles, A Harris, A Maser, J T Puchalski, C Rochester, J Possick, K Johnson, Z Dabre, K Kovitz, M Joo, J DeLisa, S V Villalan, G Krishna, J Canfield, A Marfatia, E Selley, S V Villalan, J Utz, D Midthun, R Kern, E S Edell, L L Boras, S Gay, K A Bauman, M King Han, R L Sagana, K Nelson, C Meldrum, M Jantz, H J Mehta, C Eagan, J West, A Delage, S Martel, P LeBlanc, F Maltais, Y Lacasse, N Lampron, F Laberge, J Milot, J Picard, M J Breton, M Dransfield, J M Wells, S Bhatt, P Smith, E N Seabron-Harris, K Hammond, C Egidio

Abstract

Background and objective: The RENEW trial demonstrated that bronchoscopic lung volume reduction using endobronchial coils improves quality of life, pulmonary function and exercise performance. In this post hoc analysis of RENEW, we examine the mechanism of action of endobronchial coils that drives improvement in clinical outcomes.

Methods: A total of 78 patients from the RENEW coil-treated group who were treated in one or both lobes that were deemed as the most destroyed were included in this retrospective analysis. Expiratory and inspiratory HRCT scans were used to assess lobar volume change from baseline to 12 months post coil treatment in treated and untreated lobes.

Results: Reduction in lobar RV in treated lobes was significantly associated with favourable clinical improvement. Independent predictor of the change in RV and FEV1 was the change in lobar RV reduction in the treated lobes and for change in 6MWD the absence of cardiac disease and the change in SGRQ, while the independent predictor of change in SGRQ was the change in 6MWD.

Conclusion: Our results suggest that residual lobar volume reduction in treated lobes measured by QCT is the driving mechanism of action of endobronchial coils leading to positive clinical outcomes. However, the improvement in exercise capacity and quality of life seems to be affected by the presence of cardiac disease.

Trial registration: ClinicalTrials.gov NCT01608490.

Keywords: bronchoscopy and interventional techniques; emphysema; endobronchial coils; lung volume reduction; quantitative computed tomographic analysis.

© 2020 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Figures

Figure 1
Figure 1
Scatterplot of change in TLC in treated lobes and change in RV in treated lobes, divided by difference in groups with different mechanisms of action and non‐responders. , Responders without compensatory expansion; , responders with compensatory expansion; , non‐responders (no change in lobar RV). CT, computed tomography; RV, residual volume; TLC, total lung capacity.
Figure 2
Figure 2
Scheme of potential mechanism of action of the coil treatment and effect on clinical outcomes. CT, computed tomography; FEV1, forced expiratory volume in 1 s; RV, residual volume.
Figure 3
Figure 3
Example of mechanism of action of the endobronchial coil treatment in a patient. (A) Pre‐treatment X‐ray, (B) just post treatment showing coils in position in the right upper lobe, (C) 6 weeks post right upper lobe treatment showing additional visible volume reduction of this lobe, (D) just post‐treatment left upper lobe, (E) 6 weeks post left upper lobe treatment also showing additional visible volume reduction of this lobe. Below the images, the baseline and follow‐up efficacy parameters are given for this patient. All pre‐ and post‐treatment pressure–volume curves are given at the end, showing a much more efficient expiratory loop. 6MWD, 6‐min walk distance; FEV1, forced expiratory volume in 1 s; RV, residual volume; TLC, total lung capacity.

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