Efficacy and safety of bronchoscopic lung volume reduction therapy in patients with severe emphysema: a meta-analysis of randomized controlled trials
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Yong Wang1, Tian-Wen Lai1, Feng Xu1, Jie-Sen Zhou1, Zhou-Yang Li1, Xu-Chen Xu1, Hai-Pin Chen1, Song-Min Ying1, Wen Li1, Hua-Hao Shen1,2 and Zhi-Hua Chen1
1Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
2State Key Lab of Respiratory Disease, Guangzhou, China
Zhi-Hua Chen, email: firstname.lastname@example.org
Hua-Hao Shen, email: email@example.com
Keywords: bronchoscopic lung volume reduction therapy, severe emphysema, meta-analysis, endobronchial coils, endobronchial valves
Received: February 27, 2017 Accepted: June 29, 2017 Published: July 18, 2017
BACKGROUND: Increasing randomized controlled trials (RCTs) indicate that bronchoscopic lung volume reduction (BLVR) is effective for severe emphysema. In this meta-analysis, we investigated the efficacy and safety of BLVR in patients with severe emphysema.
METHODS: PubMed, Embase and the Cochrane Library and reference lists of related articles were searched, and RCTs that evaluated BLVR therapy VS conventional therapy were included. Meta-analysis was performed only when included RCTs ≥ 2 trials.
RESULTS: In total, 3 RCTs for endobronchial coils, 6 RCTs for endobronchial valves (EBV) and 2 RCTs for intrabronchial valves (IBV) were included. Compared with conventional therapy, endobronchial coils showed better response in minimal clinically important difference (MCID) for forced expiratory volume in 1s (FEV1) (RR = 2.37, 95% CI = 1.61 – 3.48, p < 0.0001), for 6-min walk test (6MWT) (RR = 2.05, 95% CI = 1.18 – 3.53, p = 0.01), and for St. George’s Respiratory Questionnaire (SGRQ) (RR = 2.32, 95% CI = 1.77 – 3.03, p < 0.00001). EBV therapy also reached clinically significant improvement in FEV1 (RR = 2.96, 95% CI = 1.49 – 5.87, p = 0.002), in 6MWT (RR = 2.90, 95% CI = 1.24 – 6.79, p = 0.01), and in SGRQ (RR = 1.53, 95% CI = 1.22 – 1.92, p = 0.0002). Both coils and EBV treatment achieved statistically significant absolute change in FEV1, 6MWT, and SGRQ from baseline, also accompanied by serious adverse effects. Furthermore, subgroup analysis showed there was no difference between homogeneous and heterogeneous emphysema in coils group. However, IBV group failed to show superior to conventional group.
CONCLUSIONS: Current meta-analysis indicates that coils or EBV treatment could significantly improve pulmonary function, exercise capacity, and quality of life compared with conventional therapy. Coils treatment could be applied in homogeneous emphysema, but further trials are needed.
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