Two-Year Follow-up in Patients Treated With Emphysematous Lung Sealant for Advanced Emphysema

• Published in: Chest Vol. 144; no. 5; pp. 1677 - 1680
• Main Authors: Kramer, Mordechai R., MD, FCCP, Refaely, Yael, MD, Maimon, Nimrod, MD, Rosengarten, Dror, MD, Fruchter, Oren, MD, FCCP
• Format: Journal Article
• Language: English
• Published: United States 01-11-2013
• Subjects: Aged; Bronchoscopy - methods; Exercise Tolerance - physiology; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Male; Middle Aged; Pneumonectomy - methods; Pulmonary Emphysema - physiopathology; Pulmonary Emphysema - surgery; Pulmonary/Respiratory; Quality of Life; Respiratory Function Tests; Time Factors; Treatment Outcome
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.13-0446

Endoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function similar to surgery at 1 year. This case series summarizes safety and efficacy data of all patients from the initial ELS study out to 2 years. Between 1 and 2 years, there were three all-cause adverse events requiring hospitalization. One patient went on to successful lung transplant. Improvements relative to baseline in spirometry (change in FEV1 : + 14.3 ± 33.1%; change in FVC: + 5.8 ± 23.2%) and diffusing capacity (change in diffusing capacity of the lung for carbon monoxide: + 10.6 ± 20.6%) were observed at 2 years. An exponential model fit to FEV1 data at 6, 12, 18, and 24 months predicted improvements from a baseline of > 5% out to 4.1 years, similar to what has been reported following surgery. This report confirms long-term safety and efficacy following ELS therapy in advanced emphysema. Studies in a larger cohort are needed to define the role of ELS therapy in the treatment algorithm of patients with this condition.