One- to Four-Year Follow-Up of Endobronchial Lung Volume Reduction in Alpha-1-Antitrypsin Deficiency Patients: A Case Series
| Autor: | Gunnar Hillerdal, Stephanie Mindus |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Lung volume reduction medicine.medical_specialty Working capacity macromolecular substances Lung volume reduction surgery Severity of Illness Index Pulmonary function testing Prosthesis Implantation Postoperative Complications Bronchoscopy alpha 1-Antitrypsin Deficiency medicine Humans Pneumonectomy Lung function Aged Retrospective Studies Exercise Tolerance Alpha 1-antitrypsin deficiency medicine.diagnostic_test business.industry fungi Pneumothorax food and beverages Pneumonia Middle Aged respiratory system Single Lung Transplantation Surgical Instruments medicine.disease Prosthesis Failure respiratory tract diseases Surgery Treatment Outcome Pulmonary Emphysema Quality of Life Female Lung Volume Measurements business |
| Zdroj: | Respiration. 88:320-328 |
| ISSN: | 1423-0356 0025-7931 |
| Popis: | Background: Lung volume reduction surgery can improve lung function and working capacity in severe heterogeneous emphysema. Endobronchial lung volume reduction (ELVR) performed by one-way valves inserted via a flexible bronchoscope can result in a moderate but significant improvement in lung function and exercise tolerance, eliminating the surgical risks. Objectives: Most studies of this method have excluded patients with α1-antitrypsin (AAT) deficiency, but small series of cases with positive short-term outcome have been reported. The sustainability of results has been questioned and we here present our experience in AAT-deficient patients treated with ELVR followed up for up to 4 years. Methods: From August 2008 to January 2012, 15 patients were treated with ELVR. Inclusion criteria were homozygotic AAT deficiency, age 1) 15-45% of predicted, severe heterogeneous emphysema, symptoms severely restricting daily life, informed consent and absence of other serious diseases. Results: One patient coughed up valves after 2 months, 1 developed pneumothorax and had valve displacement and subsequent removal, and 1 improved from an FEV1 of 0.62 to 0.84 liters, but after 4 months developed repeated and severe pneumonia and the valves had to be removed. Thus, 12 patients remained and were followed up for at least 1 year. In these patients, FEV1 increased (mean: 54%), the quality of life was much improved, and 2 patients could be taken off oxygen therapy. During the 4-year follow-up, patients demonstrated no significant deterioration in lung function. Conclusion: In carefully selected AAT deficiency patients with severe emphysema, ELVR can be safely performed with encouraging long-lasting results. |
| Databáze: | OpenAIRE |
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