Many patients with COPD have uncontrolled symptoms despite optimal medical management, and existing surgical interventions have not always been ideal or even an option for some. Recently, though, different approaches have started to emerge.
The panel discussion, A Breath of Fresh Air: Bronchoscopic Interventions for Patients With COPD, on Monday, from 3 pm to 4 pm, in Room 313C of the convention center, will look in-depth at one approach that is gaining traction—bronchoscopic lung volume reduction (BLVR) by placement of endobronchial valves—and review other potential bronchoscopic therapies under clinical investigation.
Bronchoscopic placement of endobronchial valves is replacing the surgical lung volume reduction of emphysematous tissue at many institutions, said Session Chair, Christian Ghattas, MD, FCCP, Assistant Professor of Internal Medicine at The Ohio State University Wexner Medical Center. The surgical excision of physiologic dead space can improve lung function in a subset of patients, but costs are high, and patients with advanced COPD are not always ideal candidates for open surgery.
In contrast, BLVR is a minimally invasive approach that can improve lung function, dyspnea, and quality of life for many patients with emphysema, Dr. Ghattas said. Its use in clinical practice is just starting to ramp up after approval by the Food and Drug Administration in 2018.
“The approach is well known, but because introduction has been delayed by COVID, pulmonologists may not be as familiar with how to select the most appropriate candidates for this procedure as they might be,” he said. “For too long, bronchoscopic lung reduction has been plagued by suboptimal selection of patients for the procedure.”
Ashutosh Sachdeva, MBBS, FCCP, and Van Holden, MD, FCCP, both from the University of Maryland School of Medicine, and Vivek Murthy, MD, FCCP, from the NYU Grossman School of Medicine, will discuss selection of candidates, expected outcome and durability, and complications and procedure revisions for BLVR.
Dr. Ghattas will highlight several other bronchoscopic interventions that are under development.
For patients living with COPD with less emphysema and more symptoms of cough and shortness of breath, bronchoscopic denervation and bronchoscopic ablation are both in clinical trials and could be approved for use in the near future.
“Targeted lung denervation is intended to damage specific nerves around the airways that are responsible for airway constrictions,” Dr. Ghattas said. “Initial data have shown that the procedure is safe, and a novel device system currently in trials could help some patients with frequent COPD flares. Lung denervation has potential similar effectiveness as inhalers but the benefits are long lasting.”
Bronchoscopic thermoplasty and cryospray approaches are in clinical trials for patients with the chronic bronchitis phenotype of COPD. These approaches are designed to ablate the cells that are responsible for secreting the excessive mucus and phlegm typically seen in chronic bronchitis to reduce chronic coughing and breathing obstructions.
“After so many years without any significant improvements in treatment options,” Dr. Ghattas said, “we finally have potential realistic bronchoscopic approaches that can help our patients with COPD breathe better.”