Novel techniques for lung volume reduction and its assessment in emphysema
File(s)
Author(s)
Zoumot, Zaid
Type
Thesis
Abstract
Many patients with emphysema remain breathless despite optimal medical therapy. Non-pharmacological approaches to reduce the volume of hyperinflated lungs include lung volume reduction surgery (LVRS) which is effective in selected patients with upper lobe predominant emphysema and low exercise capacity. Bronchoscopic techniques to reduce lung volume are also being developed.
Studies of two bronchoscopic techniques to achieve lung volume reduction (LVR) are presented in this thesis; LVR coils (LVRCs) and endobronchial autologous blood instillation. In a trial of LVRCs we demonstrate for the first time in a randomised controlled setting, that treatment with LVRCs results in statistically and clinically meaningful improvements in quality of life, lung function and exercise capacity compared with controls, and that benefits are maintained up to 12 months following treatment compared to baseline. In two pilot studies, we used autologous blood instilled endobronchially aiming to achieve lung volume reduction by inducing parenchymal scarring and fibrosis. Instilling 180-240 mls of autologous blood withdrawn from patients during the bronchoscopic procedure directly into a giant bullae resulted in significant reduction in bulla size over subsequent months in three of five patients, with associated improvements in lung function, exercise capacity and quality of life. However a randomised controlled trial of instilling 60 mls of autologous blood into three segments of one lobe in patients with heterogeneous emphysema was ineffective.
In addition, I investigated the use of a novel 3-dimentional measurement system, optoelectronic plethysmography (OEP), to track abdominal and chest wall movements during respiration. This showed that successful lung volume reduction approaches were associated with significant improvements in lower rib cage paradoxical inspiratory movements after lung volume reduction. Improvements in chest wall asynchrony were larger the worse the asynchrony was at baseline, and those with larger improvements in asynchrony derived greater benefits in lung function and other clinical outcomes following LVR.
Studies of two bronchoscopic techniques to achieve lung volume reduction (LVR) are presented in this thesis; LVR coils (LVRCs) and endobronchial autologous blood instillation. In a trial of LVRCs we demonstrate for the first time in a randomised controlled setting, that treatment with LVRCs results in statistically and clinically meaningful improvements in quality of life, lung function and exercise capacity compared with controls, and that benefits are maintained up to 12 months following treatment compared to baseline. In two pilot studies, we used autologous blood instilled endobronchially aiming to achieve lung volume reduction by inducing parenchymal scarring and fibrosis. Instilling 180-240 mls of autologous blood withdrawn from patients during the bronchoscopic procedure directly into a giant bullae resulted in significant reduction in bulla size over subsequent months in three of five patients, with associated improvements in lung function, exercise capacity and quality of life. However a randomised controlled trial of instilling 60 mls of autologous blood into three segments of one lobe in patients with heterogeneous emphysema was ineffective.
In addition, I investigated the use of a novel 3-dimentional measurement system, optoelectronic plethysmography (OEP), to track abdominal and chest wall movements during respiration. This showed that successful lung volume reduction approaches were associated with significant improvements in lower rib cage paradoxical inspiratory movements after lung volume reduction. Improvements in chest wall asynchrony were larger the worse the asynchrony was at baseline, and those with larger improvements in asynchrony derived greater benefits in lung function and other clinical outcomes following LVR.
Version
Open Access
Date Issued
2014-03
Date Awarded
2014-05
Advisor
Shah, Pallav
Hopkinson, Nicholas
Publisher Department
National Heart and Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)