Interventional Pulmonologist

“There is still something more you can do…”


Do you also have patients who suffer from severe emphysema, specifically from severe breathlessness and hyperinflation? Do your patients complain about their worsening conditions regardless of optimal medical management? 
 

For patients who have the desire for a more active lifestyle, there are different interventional treatment options which may alleviate their symptoms.

One of these options is Bronchoscopic Lung Volume Reduction (BLVR) with Coils. It is effective in patients with homogeneous and/or heterogeneous severe emphysema and is independent of collateral ventilation.

(GOLD Report 2018 *)
 

Patient Selection 


Severe:

  • COPD, GOLD 3 or 4**
  • Severe emphysema (ideally, confirmed by HRCT)
  • Severe hyperinflation


Stable:

  • No hospitalisation for acute COPD exacerbations within the past two months


Symptomatic:

  • Debilitating dyspnea and decreased quality of life, despite optimal medical management, according to guidelines


Pulmonary Function Testing

  • FEV1 ≤ 45 % predicted, post-bronchodilator
  • FEV1 / FVC < 0.7
  • TLC > 100 % predicted
  • RV ≥ 175 % predicted


Comorbidities

Patients with severe COPD often suffer from comorbidities, which are associated with COPD and/or with other chronic diseases. Four or more comorbidities, or presence of cardiac comorbidities, may negatively impact a patient’s 6MWT improvement, despite pulmonary function and SGRQ improvement. That is why special attention should be paid to cardiac comorbidities. 

It is important that patients’ primary diagnosis is severe emphysema and that their breathlessness is not caused by other comorbidities. 


CT

A high-resolution CT (HRCT) with a maximum slice thickness of 1mm is needed to clearly diagnose the emphysema and to identify conditions that may affect patient selection for Coil treatment. This HRCT can also be used for a lung densitometry analysis to optimize treatment planning


Commitment

Generally, interventions should only be offered to patients who have a positive attitude and make efforts to manage their health needs.


Contraindications:

The REPNEU Endobronchial Coil System is contraindicated for use in:

  • Patients with a known sensitivity to drugs required for performing bronchoscopy or in whom bronchoscopic procedures are contraindicated
  • Patients with evidence of active infection in the lungs
  • Patients with hypersensitivity or allergy to nitinol (nickel-titanium) or its constituent metals
  • Patients with clinically significant bleeding disorders
  • Patients with clinically significant pulmonary fibrosis
  • Patients with severe bullous disease (defined by bulla >1/3 of lung volume, or single bullous defect >8cm), or significant paraseptal emphysema [defined by numerous large (>1cm) paraseptal defects in the target lobe comprising >5% of total lung volume].
  • Patients with clinically significant, generalized bronchiectasis
  • Patients with severe pulmonary hypertension defined by right ventricular systolic pressure >50mmHg (preferably measured by right heart catheterization)
    Note: For further guidance, see Section 4.3.5 – Pulmonary Hypertension***.
  • Patients taking immunosuppressive drugs other than steroids (e.g., for the treatment of cancer, rheumatoid arthritis, autoimmune disease, or prevention of tissue or organ rejection)
  • Patients taking >20 mg prednisone (or equivalent dose of a similar steroid) daily

 

*Global Strategy for the Diagnosis, Management and Prevention of COPD (2018 Report), Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2018 (www.goldcopd.org).
**GOLD 3: 30 % ≤ FEV1 < 50 % predicted; GOLD 4: FEV1 < 30 % predicted, Global Strategy for the Diagnosis, Management and Prevention of COPD (2018 Report), Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2018.
***See Section 4.3.5 of IFU LBL0139 Rev J

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