Endoscopic Treatment of Emphysema. Issue 4 (July 2016) - Kumar, Anupam
Abstract : Chronic obstructive pulmonary disease (COPD) continues to pose a major health care burden with an estimated 15.4 million office visits (in 2009) and an annual expenditure of $49.9 billion. Currently, the third most common cause of death in the United States and worldwide, COPD also compromises patients' functional status and quality of life. Emphysema is one of the many COPD phenotypes and is characterized by abnormal, irreversible destruction and enlargement of the airways distal to the terminal bronchioles. The destruction of pliable connective tissue results in the loss of elastic recoil and reduction in the gas exchange surface area of the lung. The increased compliance due to ineffective recoil leads to airway collapse in early expiration, air trapping, and dynamic hyperinflation. Because standard medical therapies for emphysema confer only modest benefit, interest has emerged in novel treatments such as lung-volume reduction surgery and endoscopic approaches to lung-volume reduction. Selected patients with advanced emphysema may be candidates for surgical modalities such as lung-volume reduction or lung transplantation. Surgical techniques, although considered as the gold standard by many, are fraught with potential issues including the cost, morbidity, mortality, and limited resources as well as biases against invasive procedures. These limitations of available treatments invite alternative, novel therapies such as minimally invasive bronchoscopic techniques for lung-volume reduction in patients with advanced emphysema. This paper reviews physiology of lung-volume reduction, followed by a discussion of the experience with available endoscopic approaches to lung-volume reduction and patient selection criteria.