Bronchoscopic Lung Volume Reduction: A 2018 Review and Update

Abstract

Bronchoscopic lung volume reduction (BLVR) procedure has expanded the treatment spectrum of patients with end-stage emphysema.These treatments include valve, coil, thermal vapor ablation, bio-lung volume reduction, targeted lung denervation, and airway bypassstent. This short review provides an up-to-date information on BLVR treatments, their clinical benefits, and an overview of complications.BLVR treatments generally affect dyspnea by reducing hyperinflation and residual volume (RV). Benefits of treatment are associated withimprovement in lung function parameters (forced expiration volume in the first second, total lung capacity, RV, and 6-minute walkingtest) and quality of life. Serious potential pulmonary complications, such as pneumothorax, pneumonia, respiratory failure, and chronicobstructive pulmonary disease exacerbation, may also occur after BLVR treatment. In addition to these, low-cost BLVR methods, suchas autologous blood and fibrin glue, are in the developmental stage. Bronchoscopic lung volume reduction treatments are a promisingmethod with positive results for patients with severe emphysema. The widespread use of these techniques, inadequate selection ofpatients, and non-critical and, therefore, unsuccessful use of BLVR in non-specialist centers lead to a false negative impression of theeffectiveness of these techniques. In addition to these considerations, it is obvious that these treatments, which are quite expensive, areburdening social health systems. The reduction of costs or the development of lower-cost treatment methods is important for the futureand for the availability of treatments.