Lung volume reduction coil (LVRC) treatment is safe and effective in heterogeneous and homogeneous emphysema

Rationale: The Lung Volume Reduction Coil (LVRC, PneumRx Inc.) is a bronchoscopic device for treatment of severe emphysema. Three multicenter European studies assessed the safety and efficacy of LVRC treatment in emphysema. Methods: 109 patients (mean age: 61 yrs, FEV 1 : 29%, RV: 242%) were treated by bilateral LVRC performed in two separate procedures. Data were analyzed at 6 and 12-months post treatment. A post-hoc blinded CT analysis was performed using a visual approach grading from 0 (minimal damage, scattered small centrilobular defects) to 4 (panlobular emphysema and complete loss of secondary lobular structure), a difference of ≤1 point defining homogeneous emphysema. Results: 2081 LVRC were placed (mean 9.5 per lobe). Serious adverse events (SAE) at 30 days following treatments were 6 % COPD exacerbations, 0.5 % haemoptysis, 5% pneumonia, 4% pneumothorax, and no death or acute respiratory failure. All SAE resolved with standard care. Changes from baseline at 6 and 12 months in heterogeneous emphysema were: FEV 1 : +19.3 and +18%, RV: -9.7 and -9.6%, 6-min walking distance (6MWD): +47 and +57m, quality of life (SGRQ): -13.8 and -12.3 pts (all, p 1 : +9.8 and +12.2%, RV: -10.2 and -10.5%, 6MWD: +42 and +55m, quality of life (SGRQ): -9.4 and -9 pts (all, p 0.05). Conclusion: LVRC treatment results in clinically relevant improvements in lung function, exercise capacity and quality of life in homogeneous and heterogeneous emphysema, with sustained improvements beyond one year.