Novel Technique Promises a Lung Sealant for Emphysema
The results of this and similar nonsurgical treatments for hyperinflation associated with COPD provide a proof of concept. Reducing the volume of nonfunctional emphysematous lung tissue allows space for less damaged lung tissue to expand and function more effectively. The present trial does not indicate how long the benefit of the procedure will last. Previous studies suggest that following several months of improvement, lung function will deteriorate and decline once more.
The procedure needs to be refined, but the range of efficacy in the treatment group in the present trial and previous trials is striking. Considering just the change in FEV1, a few patients experienced a deterioration of 20% at 6 months. Some patients experienced an improvement of more than 100% increase in FEV1. This suggests that there is either a broad range of pathology or that the technology of the volume reduction is a large factor in the success of the procedure. We learned from NETT that the surgical procedure works best when the lung disease is heterogeneous and predominantly in the upper lobe, providing an appropriate target for the surgery. Selection of the patient and the target are equally important with the lung sealant procedure, which requires good judgement on the part of the operator and good radiologic assessment of the location and extent of disease. Many of those judgements are to some extent arbitrary. In the present trial, selection for enrollees was very strict, yet some patients did poorly and a few died.
The symptoms of emphysema can be so severe that some patients would be willing to risk a dire outcome, even if the improvement was relatively short-lived.
Viewpoint
The results of this and similar nonsurgical treatments for hyperinflation associated with COPD provide a proof of concept. Reducing the volume of nonfunctional emphysematous lung tissue allows space for less damaged lung tissue to expand and function more effectively. The present trial does not indicate how long the benefit of the procedure will last. Previous studies suggest that following several months of improvement, lung function will deteriorate and decline once more.
The procedure needs to be refined, but the range of efficacy in the treatment group in the present trial and previous trials is striking. Considering just the change in FEV1, a few patients experienced a deterioration of 20% at 6 months. Some patients experienced an improvement of more than 100% increase in FEV1. This suggests that there is either a broad range of pathology or that the technology of the volume reduction is a large factor in the success of the procedure. We learned from NETT that the surgical procedure works best when the lung disease is heterogeneous and predominantly in the upper lobe, providing an appropriate target for the surgery. Selection of the patient and the target are equally important with the lung sealant procedure, which requires good judgement on the part of the operator and good radiologic assessment of the location and extent of disease. Many of those judgements are to some extent arbitrary. In the present trial, selection for enrollees was very strict, yet some patients did poorly and a few died.
The symptoms of emphysema can be so severe that some patients would be willing to risk a dire outcome, even if the improvement was relatively short-lived.
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