Interventional bronchoscopic treatments in COPD
Advanced Thoracic Surgery, Akademisyen Kitabevi, ss.809-820, 2021
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2021
- Yayınevi: Akademisyen Kitabevi
- Sayfa Sayıları: ss.809-820
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Chronic obstructive pulmonary disease (COPD) is characterized by the narrowing of the respiratory airways due to continuous respiratory symptoms and exposure to noxious particles or gases. This is a common, preventable, and treatable disease. COPD consists of two components, emphysema and chronic bronchitis. In the emphysema phenotype, air cannot escape from the lungs sufficiently due to bronchoconstriction and early small airway collapse, leading to excessive lung ventilation (hyperinflation) over the years. The effects of medical and other treatments (such as smoking cessation, beta-2 agonists, anticholinergic drugs, oral-inhaled steroids, oxygen therapy, and pulmonary rehabilitation) are very limited in reducing this hyperinflation. Surgical lung volume reduction (SLVR) has been considered as a therapeutic alternative for patients with advanced obstructive lung disease in the National Emphysema Treatment Trial (NETT) study. Despite high mortality rates (16% within 30 days, 7.9% within 90 days), significant and durable improvements in exercise capacity and health-related quality of life have been observed for up to 3 to 4 years, particularly in the subgroup with dominant upper lobe/low baseline exercise capacity. Mortality has mainly been observed in patients with homogeneous emphysema. The 2016 Cochrane review found clinically significant benefits of SLVR in lung function, exercise capacity, quality of life, and survival, especially in selected individuals with dominant upper lobe emphysema/low baseline exercise capacity, and it was found to be the most effective compared to medical treatments. However, early postoperative complications, high mortality rates, and the cost of surgery have led to the development of bronchoscopic SLVR. The main aim of bronchoscopic SLVR is to reduce excessive lung ventilation. In patients with chronic bronchitis, it aims to provide remodeling by providing permanent dilation of the bronchial mucosa without scar tissue formation and reducing excessive mucus production. Proper patient selection is the most important factor affecting the success of bronchoscopic treatment. In patients who continue to experience shortness of breath despite optimal medical treatment, smoking cessation, and pulmonary rehabilitation, interventional bronchoscopic treatment options are recommended.