Correspondence: Nicolas Roche, Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin Broca HôtelDieu, Site HIA du Val de Grâce 4eC, 74 Bd de Port Royal, 75005 Paris, France. Email: [email protected] Received: July 18 2014 | Accepted after revision: Aug 30 2014 | First published online: Oct 30 2014 Support statement: This study was supported by an unrestricted grant from Boehringer Ingelheim and Pfizer. Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com
References 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jun11.pdf Date last updated: June 11, 2014. Vogelmeier C, Hederer B, Glaab T, et al. Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med 2011; 364: 1093–1103. Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–789. Karner C, Cates CJ. Combination inhaled steroid and long-acting β2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 3: CD008532. Sharif R, Cuevas CR, Wang Y, et al. Guideline adherence in management of stable chronic obstructive pulmonary disease. Respir Med 2013; 107: 1046–1052. Burgel PR, Deslée G, Jebrak G, et al. Real-life use of inhaled corticosteroids in COPD patients versus the GOLD proposals: a paradigm shift in GOLD 2011? Eur Respir J 2014; 43: 1201–1203. Fitch K, Iwasaki K, Pyenson B, et al. Variation in adherence with Global Initiative for Chronic Obstructive Lung Disease (GOLD) drug therapy guidelines: a retrospective actuarial claims data analysis. Curr Med Res Opin 2011; 27: 1425–1429. Jochmann A, Scherr A, Jochmann DC, et al. Impact of adherence to the GOLD guidelines on symptom prevalence, lung function decline and exacerbation rate in the Swiss COPD cohort. Swiss Med Wkly 2012; 142: w13567. Asche CV, Leader S, Plauschinat C, et al. Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids. Int J Chron Obstruct Pulmon Dis 2012; 7: 201–209. Antón E. How and when to use inhaled corticosteroids in chronic obstructive pulmonary disease? Expert Rev Respir Med 2013; 7: 25–32. De Backer W, Vos W, Van Holsbeke C, et al. The effect of roflumilast in addition to LABA/LAMA/ICS treatment in COPD patients. Eur Respir J 2014; 44: 527–529. Page C, Cazzola M. Bifunctional drugs for the treatment of asthma and chronic obstructive pulmonary disease. Eur Respir J 2014; 44: 475–482. Agustí A, de Teresa L, De Backer W, et al. A comparison of the efficacy and safety of once-daily fluticasone furoate/vilanterol with twice-daily fluticasone propionate/salmeterol in moderate to very severe COPD. Eur Respir J 2014; 43: 763–772. Spagnolo P, Fabbri LM, Bush A. Long-term macrolide treatment for chronic respiratory disease. Eur Respir J 2013; 42: 239–251. Eur Respir J 2015; 45: 260–262 | DOI: 10.1183/09031936.00131614 | Copyright ©ERS 2015
Volumetric and scintigraphic changes following endoscopic lung volume reduction To the Editor: Bronchoscopic treatment of emphysema represents an emerging therapeutic modality for advanced emphysematous lung destruction in chronic obstructive pulmonary disease (COPD). Within the proposed techniques for endoscopic lung volume reduction (ELVR), a significant amount of experience exists for the placement of endobronchial valves (EBV) (Zephyr® valves; Pulmonx, Inc., Redwood City, CA, USA) targeting atelectasis of the treated, emphysematous lobe [1, 2]. However, post-procedural clinical
262
improvement has also been documented in patients lacking lobar exclusion 3. While volumetric and density adaptations following ELVR have repeatedly been a focus [3, 4], the interaction of volume and perfusional/ventilatory changes remains unclear. In this observational study, we defined the extent of interdependency of ELVR-mediated volumetric and scintigraphic adaptations. Among 36 patients receiving ELVR by EBV insertion at the Dept of Pneumology, University Hospital Bonn (Bonn, Germany) from November 2012 to February 2014, 24 patients were offered pre- and post-procedural imaging and qualified as eligible for inclusion in this study. As a pre-requisite for performance of ELVR, patients were required to meet the inclusion criteria of the Endobronchial Valve for Emphysema Palliation Trial (VENT) study [1]. Exclusion criteria for ELVR and consequently for study inclusion comprised continued nicotine consumption and frequent respiratory exacerbations (⩾2 exacerbations per year). Flexible bronchoscopy was performed by an experienced bronchoscopist and executed under moderate sedation with propofol and midazolam, permitting spontaneous breathing. Absence of collateral ventilation as assessed by the Chartis® Pulmonary Assessment System (Pulmonx, Inc.) allowed for EBV placement [5]. The study had the approval of the local ethics committee. The day prior to ELVR and 8 weeks afterwards, all patients underwent pulmonary function assessment, 6-min walk test (6MWT), COPD Assessment Test and N-terminal pro-brain natriuretic peptide (NT-proBNP) testing. In the same time interval, ventilation/perfusion scintigraphy was conducted and complemented by single-photon emission computed tomography (SPECT)/low-dose computed tomography imaging (scan parameters: 130 kVm 17 mAs, 5-mm slices). Scintigraphy and SPECT analyses were performed by experienced local nuclear physicians, blinded to the patient’s clinical performance, by use of OsiriX® Medical Imaging Software (an open-source project; Pixmeo, Geneva, Switzerland). Continuous variables were evaluated by use of paired t-test, categorical parameters by Pearson’s Chi-squared test. A value of p
References 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jun11.pdf Date last updated: June 11, 2014. Vogelmeier C, Hederer B, Glaab T, et al. Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med 2011; 364: 1093–1103. Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–789. Karner C, Cates CJ. Combination inhaled steroid and long-acting β2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 3: CD008532. Sharif R, Cuevas CR, Wang Y, et al. Guideline adherence in management of stable chronic obstructive pulmonary disease. Respir Med 2013; 107: 1046–1052. Burgel PR, Deslée G, Jebrak G, et al. Real-life use of inhaled corticosteroids in COPD patients versus the GOLD proposals: a paradigm shift in GOLD 2011? Eur Respir J 2014; 43: 1201–1203. Fitch K, Iwasaki K, Pyenson B, et al. Variation in adherence with Global Initiative for Chronic Obstructive Lung Disease (GOLD) drug therapy guidelines: a retrospective actuarial claims data analysis. Curr Med Res Opin 2011; 27: 1425–1429. Jochmann A, Scherr A, Jochmann DC, et al. Impact of adherence to the GOLD guidelines on symptom prevalence, lung function decline and exacerbation rate in the Swiss COPD cohort. Swiss Med Wkly 2012; 142: w13567. Asche CV, Leader S, Plauschinat C, et al. Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids. Int J Chron Obstruct Pulmon Dis 2012; 7: 201–209. Antón E. How and when to use inhaled corticosteroids in chronic obstructive pulmonary disease? Expert Rev Respir Med 2013; 7: 25–32. De Backer W, Vos W, Van Holsbeke C, et al. The effect of roflumilast in addition to LABA/LAMA/ICS treatment in COPD patients. Eur Respir J 2014; 44: 527–529. Page C, Cazzola M. Bifunctional drugs for the treatment of asthma and chronic obstructive pulmonary disease. Eur Respir J 2014; 44: 475–482. Agustí A, de Teresa L, De Backer W, et al. A comparison of the efficacy and safety of once-daily fluticasone furoate/vilanterol with twice-daily fluticasone propionate/salmeterol in moderate to very severe COPD. Eur Respir J 2014; 43: 763–772. Spagnolo P, Fabbri LM, Bush A. Long-term macrolide treatment for chronic respiratory disease. Eur Respir J 2013; 42: 239–251. Eur Respir J 2015; 45: 260–262 | DOI: 10.1183/09031936.00131614 | Copyright ©ERS 2015
Volumetric and scintigraphic changes following endoscopic lung volume reduction To the Editor: Bronchoscopic treatment of emphysema represents an emerging therapeutic modality for advanced emphysematous lung destruction in chronic obstructive pulmonary disease (COPD). Within the proposed techniques for endoscopic lung volume reduction (ELVR), a significant amount of experience exists for the placement of endobronchial valves (EBV) (Zephyr® valves; Pulmonx, Inc., Redwood City, CA, USA) targeting atelectasis of the treated, emphysematous lobe [1, 2]. However, post-procedural clinical
262
improvement has also been documented in patients lacking lobar exclusion 3. While volumetric and density adaptations following ELVR have repeatedly been a focus [3, 4], the interaction of volume and perfusional/ventilatory changes remains unclear. In this observational study, we defined the extent of interdependency of ELVR-mediated volumetric and scintigraphic adaptations. Among 36 patients receiving ELVR by EBV insertion at the Dept of Pneumology, University Hospital Bonn (Bonn, Germany) from November 2012 to February 2014, 24 patients were offered pre- and post-procedural imaging and qualified as eligible for inclusion in this study. As a pre-requisite for performance of ELVR, patients were required to meet the inclusion criteria of the Endobronchial Valve for Emphysema Palliation Trial (VENT) study [1]. Exclusion criteria for ELVR and consequently for study inclusion comprised continued nicotine consumption and frequent respiratory exacerbations (⩾2 exacerbations per year). Flexible bronchoscopy was performed by an experienced bronchoscopist and executed under moderate sedation with propofol and midazolam, permitting spontaneous breathing. Absence of collateral ventilation as assessed by the Chartis® Pulmonary Assessment System (Pulmonx, Inc.) allowed for EBV placement [5]. The study had the approval of the local ethics committee. The day prior to ELVR and 8 weeks afterwards, all patients underwent pulmonary function assessment, 6-min walk test (6MWT), COPD Assessment Test and N-terminal pro-brain natriuretic peptide (NT-proBNP) testing. In the same time interval, ventilation/perfusion scintigraphy was conducted and complemented by single-photon emission computed tomography (SPECT)/low-dose computed tomography imaging (scan parameters: 130 kVm 17 mAs, 5-mm slices). Scintigraphy and SPECT analyses were performed by experienced local nuclear physicians, blinded to the patient’s clinical performance, by use of OsiriX® Medical Imaging Software (an open-source project; Pixmeo, Geneva, Switzerland). Continuous variables were evaluated by use of paired t-test, categorical parameters by Pearson’s Chi-squared test. A value of p
![[Endoscopic lung volume reduction].](/assets/img/hold.png)
