This a single center non-randomised non-sham controlled intervention study evaluating the effectiveness and safety of endoscopic lung volume reduction by endobronchial valves
The primary objective of the current study is to explore the effect of targeted lobar endobronchial lung volume reduction in symptomatic patients with severe emphysema and absent collateral ventilation, on lung function, exercise capacity and physical activity. As a secondary objective, changes in physical activity as result of a 3 month activity coaching program delivered between 3 to 6 months post intervention will be investigated. Exploratory objectives are to extend insight in the clinical characteristics of responders and non-responders and to address relationships between lung function response, physical functioning and its impact on inflammation, skeletal and cardiac function. Furthermore, comparison of the effects on lung function, exercise capacity, quality of life and physical activity between endoscopic lung volume reduction and surgical lung volume reduction will be made. The study will also explore if treatment response can be optimised by an intermediate evaluation with CT scan one month after intervention. Endoscopic evaluation and repositioning of the endobronchial valves will be imposed in case no lober atelectasis is visualised. .
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
40
A ambulatory diagnostic bronchoscopy under general anesthesia will evaluate the presence or absence of collateral ventilation . The targeted lobar airway is temporarily occluded by means of a balloon catheter, which blocks inspiratory flow but allows expiratory flow, in order to assess whether the air flow gradually declines to zero, meaning absence of collateral ventilation. Only in case collateral ventilation is excluded, a therapeutic bronchoscopy will be scheduled to insert the one-directional endobronchial valves in the targeted lobar airways. We will only perform a unilateral intervention during which we will treat one or maximal two lobes at one side.
3 month physical activity tele coaching intervention consisting of a project tailored smartphone application in combination with a step counter providing direct feedback.
UZ Leuven
Leuven, Flanders, Belgium
RECRUITINGresponse rate of FEV1 at 3 months post intervention
proportion of patients with a minimal change of FEV1 \> 100 ml
Time frame: 3 months
response rate on SGRQ at 3 months and 6 months post intervention
proportion of patients with a minimal change of -4 points on SGRQ
Time frame: 3 months and 6 months post intervention
response rate on 6 minutes walking distance (6MWD) at 3 months and 6 months post intervention
proportion of patients with a minimal improvement of 30 meters on 6MWD
Time frame: 3 months and 6 months post intervention
response rate on residual volume (RV) at 3 months and 6 months post intervention
proportion of patients with a minimal reduction of 400 ml on residual volume
Time frame: 3 months and 6 months post intervention
response rate on FEV1 at 6 months post intervention
proportion of patients with a minimal change of FEV1 \> 100 ml
Time frame: 6 months
response rate on Transitional dyspnee index (TDI) at 3 months and 6 months post intervention
proportion of patients with a minimal change of -1 point on TDI
Time frame: 3 months and 6 months post intervention
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Patients not eligible for endoscopic lung volume reduction (or non responders of this intervention) can be referred for surgical lung volume reduction. With this procedure, the most emphysematous parts of the lungs will be surgically removed.