A GOLD Stage 3 COPD Patient «Cured» by One-Way Endobronchial Valve

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A 69 year old woman was referred for lung volume reduction. She had a history of COPD with increasing dyspnea over 6 years. Her medical history included past smoking (40 pack years, stopped 17 years earlier), uncomplicated arterial hypertension, and type 2 diabetes. Her treatment included inhaled tiotropium and salmeterol/fluticasone, levothyroxine, valsartan, hydrochlorothiazide, metformin.

She complained of dyspnea grade 2 to 3 (mMRC- scale). The COPD assessment test (CAT) score was 24/40. She acknowledged a sedentary lifestyle. She experienced less than one exacerbation per year.

Her physical examination revealed diminished breath sounds on the right hemithorax. Besides overweight (BMI 29.5 kg/m²), it was otherwise unremarkable.

Spirometry showed severe airway obstruction (GOLD stage 3; Table). Plethysmography revealed significant hyperinflation. Lung diffusion was relatively preserved. She walked 342 meters on a 6 minute walk test with some oxygen desaturation (97 to 92%). The BODE index was 5/10.

A high-resolution computed chest tomography (HRCT) showed mixed mild paraseptal and centrolobular emphysema in both lungs with emphysematous destruction of the right lower lobe and flattened diaphragm (Black star on figure). The latter was associated with contralateral mediastinal shift along with complete passive middle lobe atelectasis and partial atelectasis of the right upper lobe. Review of HRCTs performed 1 and 6 years earlier in another hospital showed that the right lower lobe experienced progressive distension.

The patient was deemed to be a good candidate for one-way endobronchial valve lung volume reduction. She was first included in a pulmonary rehabilitation (PR) program, without significant improvement (Table).

Two one-way endobronchial valves (Zephyr ; PulmonX, delivered by RMS Medical Devices) were placed in the right lower lobe under general anesthesia, after exclusion of collateral ventilation using the Chartis system.

After 1 and 3 months, the patient reported marked improvement. She was no longer limited by dyspnea. Her CAT score improved as did the 6-minute walk distance. HRCT showed a marked reduction in the left lower lobe volume with an increased right upper lobe volume and disappearance of the mediastinal shift. Even more remarkable was the improvement of spirometry. Indeed, the patient no longer met the spirometric criteria for COPD according to the GOLD initiative (Table).

This case illustrates the potential for dramatic improvement after lung volume reduction after endobronchial valves treatment. Hyperinflation of the excluded lobe with compression and displacement of the adjacent lung should be tested as predictor of treatment success after endonronchial valve therapy.
langue originaleAnglais
Etat de la publicationPublié - mai 2017
EvénementAmerican Thoracic Society 2017 International Conference - Washington DC, États-Unis
Durée: 19 mai 201724 mai 2017

Une conférence

Une conférenceAmerican Thoracic Society 2017 International Conference
La villeWashington DC

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