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The localized inflammatory response to bronchoscopic thermal vapor ablation

<b><i>Background:</i></b> Bronchoscopic thermal vapor ablation (BTVA) reduces lung volumes in emphysema patients by inducing a localized inflammatory response (LIR) leading to a healing process of fibrosis, but may also increase symptoms. <b><i>Objectives:</i&g...

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Main Authors: Gompelmann, Daniela (Author) , Eberhardt, Ralf (Author) , Ernst, Armin (Author) , Hopkins, Peter (Author) , Egan, Jim (Author) , Stanzel, Franz (Author) , Valipour, Arschang (Author) , Wagner, Manfred (Author) , Witt, Christian (Author) , Baker, Kimberly M. (Author) , Gotfried, Mark H. (Author) , Kesten, Steven (Author) , Snell, Gregory (Author) , Herth, Felix (Author)
Format: Article (Journal)
Language:English
Published: August 23, 2013
In: Respiration
Year: 2013, Volume: 86, Issue: 4, Pages: 324-331
ISSN:1423-0356
DOI:10.1159/000354175
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1159/000354175
Verlag, lizenzpflichtig, Volltext: https://www.karger.com/Article/FullText/354175
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Author Notes:Daniela Gompelmann, Ralf Eberhardt, Armin Ernst, Peter Hopkins, Jim Egan, Franz Stanzel, Arschang Valipour, Manfred Wagner, Christian Witt, Kimberly M. Baker, Mark H. Gotfried, Steven Kesten, Gregory Snell, Felix J.F. Herth
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Summary:<b><i>Background:</i></b> Bronchoscopic thermal vapor ablation (BTVA) reduces lung volumes in emphysema patients by inducing a localized inflammatory response (LIR) leading to a healing process of fibrosis, but may also increase symptoms. <b><i>Objectives:</i></b> We sought to evaluate whether the clinical manifestation of LIR correlated with patient outcome. <b><i>Methods:</i></b> Respiratory adverse events and inflammatory markers were analyzed from a multicenter trial of BTVA in patients with upper-lobe-predominant emphysema. End points including changes in forced expiratory flow (FEV<sub>1</sub>), lobar volume, St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) and 6-minute-walk distance (6-MWD) were analyzed according to the presence or absence of a respiratory adverse event requiring treatment with an antibiotic or steroid. <b><i>Results:</i></b> Forty-four patients received BTVA. Increases of inflammatory markers were observed with a peak between the second and fourth week. Eighteen respiratory adverse events occurred in 16 patients within 30 days of BTVA, requiring antibiotics and/or steroids. These patients had significantly greater lobar volume reduction (65.3 vs. 33.4%, p = 0.007) and a change in residual volume at 12 months (-933 vs. 13 ml, p < 0.001) associated with a greater improvement of exercise capacity and health-related quality of life than patients without respiratory adverse events. <b><i>Conclusion:</i></b> Patients with more prominent respiratory symptoms in the first 30 days following BTVA experience greater efficacy. The clinical manifestations of the LIR are predictive of long-term clinical benefits.
Item Description:Gesehen am 18.02.2020
Physical Description:Online Resource
ISSN:1423-0356
DOI:10.1159/000354175

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