Bronchoscopic volume reduction - A safe and effective alternative to surgical therapy for emphysema

Lung volume reduction surgery (LVRS), the removal of damaged, hyperexpanded lung, has been shown to improve respiratory function in many patients with end-stage emphysema. We report the results of an animal study using a new transbronchoscopic alternative to LVRS in which a washout solution and fibr in-based glue are used to collapse, seal, and scar target regions of abnorm al lung. Twelve sheep had static and dynamic lung functions measured at bas eline. Emphysema was produced by inhaled papain (7,000 U/wk X 4 wk), result ing in a significant increase of lung volumes, compliance, and airway resis tance. The animals were then divided into three treatment groups of four an imals, and underwent surgical volume reduction (SVR), bronchoscopic volume reduction (BVR), or bronchoscopy alone (Sham-BVR). Response to each interve ntion was assessed 8 to 12 wk after treatment by measuring lung function an d examining lung tissue. BVR and SVR groups responded with significant and similar decreases in TLC and residual volume (RV). Tissue examination demon strated that BVR caused collapse of the lung with focal scarring in II of 2 0 target territories (55% success rate). Three of the II target zones devel oped sterile abscesses. Postprocedure complications were less frequent with BVR than with SVR. This pilot study suggests that lung volume reduction ca n be achieved in animals without surgery using a bronchoscopic approach and a novel fibrin-based glue system. BVR has the potential for simplifying vo lume reduction, extending indications, and reducing morbidity, mortality, a nd costs in humans.