Endobronchial coiling for emphysema associated with moderate improvement in exercise tolerance

1. At 1 year, patients with severe emphysema who received bilateral endobronchial coils demonstrated modest improvements in expiratory flow rate and exercise tolerance.

2. The use of endobronchial coils was associated with higher rates of complications, including pneumothorax, pneumonia, and hemoptysis.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Emphysema is one of several diseases comprising Chronic Obstructive Pulmonary Disease (COPD). It results from a weakening and rupture of alveolar walls, thereby creating larger air spaces with less surface area available for oxygen exchange. Treatments range widely, from bronchodilators and steroids, to lung volume reduction surgery and lung transplant. However, effective treatments are limited for patients with advanced emphysema. Endobronchial coils, novel medical devices that compress emphysematous tissue, have shown promising results to date in such advanced patients, and this study sought to assess the safety and effectiveness of these coils.

The authors of this study determined that, at 1-year of follow-up, implantation of endobronchial coils resulted in a modest increase in exercise tolerance, as assessed by a 6-minute walk distance exam. However, a number of major complications were also increased. This study was strengthened by its large sample population and long follow-up time, but was limited by its dependence on a single gauge of exercise tolerance as well as its difficulty in implementing a sham surgery control group. While endobronchial coils appear promising to date, research into this treatment will continue for 5 years, providing a clearer picture of the post-surgical implications of this treatment option.

Click to read the study in JAMA

Relevant Reading: Lung volume reduction coil treatment vs usual care in patients with severe emphysema

In-Depth [randomized controlled trial]: This study examined a total of 315 patients between December 2012 and November 2015. Patients were enrolled at 34 sites; with 158 randomized to endobronchial coil treatment and 157 assigned to usual care. The primary endpoint was the change in 6-minute walk distance at 12 months after operation. Among those who received endobronchial coils, their walk distance improved by 10.3 meters (IQR -33.0 to 45.0 meters) while those who received usual care were only able to walk shorter distances after year (-7.6 meters; IQR -40.0 to 26.0). The difference in respiratory symptoms as assessed by the St. George’s Respiratory Questionnaire was improved in the endobronchial coil group as well (difference -8.9 points; 97.5%CI -∞ to -6.3). Levels of FEV1 were 3.8% higher (IQR -6.3% to 16.1%) in coil treated patients vs. 2.5% lower (IQR -8.9% to 4.4%) in the usual care group. Major complications occurred more frequently in the coil group (34.8%) than the usual care group (19.1%; p < 0.001).

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