Background: Both bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pulmonary rehabilitation (PR) are effective treatments for improving exercise capacity and patient-reported outcomes in patients with severe Chronic Obstructive Pulmonary Disease (COPD). Aim To study the impact and timing of PR in patients who underwent BLVR-EBV. Methods: We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV, or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up between the PR groups and BLVR-EBV only group. Secondary endpoints included changes in six-minute walking test, daily step count, and patient-reported outcomes. Results: Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR groups and BLVR-EBV alone (median: 376 [IQR: 26; 906] vs. 601 [73; 1003] seconds, p=0.416) or any of the secondary endpoints. Similarly, we found no differences in change in CWRT endurance time between the groups that underwent PR before and after BLVR-EBV (421 [44; 1304] vs. 292 [17; 630] seconds, p=0.210) or in the secondary endpoints. Conclusion: The combination of PR and BLVR-EBV did not result in increased exercise capacity, daily step count, or improved patients-reported outcomes compared to BLVR-EBV alone. The timing of PR in relation to BLVR-EBV did not affect treatment efficacy.
Introduction: Endobronchial valves (EBV) are an effective treatment in highly selected COPD patients with advanced emphysema. Aims: To evaluate a spectrum of treatable traits (TTs) in COPD patients eligible for EBV, stratified for higher or lower health-related quality of life (HRQL). Methods: The SoLVE study (NCT03474471) was a prospective multicenter RCT on the systemic effects of EBV. At baseline, a comprehensive assessment was performed including lung function, exercise capacity, muscle strength, physical activity and patient reported outcome measures. Subjects were divided into higher or lower HRQL based on the St. George's Respiratory Questionnaire total score (SGRQ < or ≥60 points). TTs were calculated on pre-defined thresholds. Logistic regression assessed the odds ratio (OR) of having a SGRQ of ≥60 points per TT. Results: In total, 97 subjects were included: 62±7 yrs, 37% male, mean FEV1 27±7% pred, RV 251±45% pred and a mean SGRQ score of 60±12 points, with 53% scoring ≥60 points. The mean number of TTs per patient was 4.5±1.8, 3.1±1.4 in SGRQ <60 points and 5.4±1.3 in SGRQ ≥60 points (P<0.05). Severe fatigue, measured with Checklist Individual Strength, had the highest OR (6.48). Conclusions: A high prevalence and co-occurrence of multiple TTs could be identified in emphysema patients eligible for EBV. These results justify to study the efficacy of the combination of EBV treatment and pulmonary rehabilitation.
Abstract A significant proportion of COVID-19 survivors still experience a reduced diffusion capacity three and twelve months after discharge. We aimed to compare pulmonary function trajectories between hospitalized COVID-19 patients with pre-existing respiratory disease (PRD) and patients without pre-existing respiratory disease (Non-PRD) at three and twelve months after hospital discharge. This single-centre retrospective cohort study included COVID-19 patients admitted to the VieCuriMedical Centre (Venlo, the Netherlands) between February and December 2020 that were invited to the outpatient clinic at three and twelve months after discharge. During this visit, pulmonary function tests were performed and impairments were based on lower limit of normal. Data of 239 patients were analysed (65% male, 66±10 years, and 26% with a history of respiratory disease). Three months after discharge, 49% and 64% of the Non-PRD patients (n=177) and PRD patients (n=62) had a low diffusion capacity, respectively. This improved over time in Non-PRD patients (p=0.003), but not in PRD patients (p=0.250). A low diffusion capacity was still observed in 34% and 57% of the Non-PRD and PRD group, respectively, twelve months after discharge. Pulmonary function impairments, mainly a reduced diffusion capacity, are observed among hospitalized COVID-19 patients with PRD and Non-PRD, at three and twelve months follow-up. Although diffusion capacity impairments restore over time in Non-PRD patients, poor recovery was observed among PRD patients.
Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program.In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes.A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention.Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT -4 ± 6 points, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ.Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.
