Bronchoscopic treatment options for chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a major causeof high mortality and morbidity worldwide. Symptoms of thedisease are usually related with the results of pulmonary dynamichyperinflation. Treatment options are classified as invasivenoninvasiveand mostly tend to be palliative. Lung volumereduction techniques are invasive part of the treatment and canbe performed by surgical or bronchoscophic methods. Becauseof the low complication rates bronchoscophic methods becamemore popular in recent years. Patients presenting with severe airtrapping and thoracic hyperinflation have the greatest potentialto derive benefit from volume reduction procedures. Assessmentof patients should ideally include cardiological evaluation, highresolution CT scan, ventilation and perfusion scintigraphy, fullpulmonary function tests, and cardiopulmonary exercise testing.There are three main groups of bronchoscophic volumereduction, direct effect on lung parenchyma, airway bypassand blocking the airways. Indications and contraindicationsare different for each modality and device. Patients who havedeterioration despite habitual changes and medical therapiesshould be evaluated for volume reduction procedures.