الفهرس 
emphysema-Only 14 pages are availabe for public view
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Abstract
Lung volume-reduction surgery is a proven palliative procedure for emphysema, and in patients with heterogeneous upper-lobe disease as well as low baseline exercise capacity, even mortality benefits can be realized. However, its application is limited by high postoperative morbidity and stringent selection criteria that effectively exclude many patients. This has been the impetus for the development of less-invasive approaches to lung volume reduction. A range of different bronchoscopic techniques, such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been investigated. The underlying physiological mechanisms of the various endoscopic modalities differ and both homogeneous, as well as heterogeneous, emphysema have been targeted. The currently avail- able data on efficacy of bronchoscopic lung volume reduction are not conclusive, although subjective benefit in dyspnea scores and quality of life is a frequent finding. Improvements in objective outcomes, such as spirometry or exercise tolerance, have been only modest. Refining patient selection and dose of treatment are subjects of ongoing research to improve the efficacy data. Safety profiles are more promising, with rare procedure-related mortality and fewer com- plications experienced than with surgical lung volume reduction. The field of bronchoscopic lung volume reduction continues to evolve, with the aim of making symptom palliation more available to a wider range of patients at lower risks.
COPD is defined as a preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. (Wacker et al, 2014).
Emphysema is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis (Wacker et al, 2014).
The aim of this work was to evaluate the safety and efficacy of bronchoscopic biological lung volume reduction using histoacryl blue gel in 40 patients with diffuse emphysema and emphysematous bulla. The youngest patient among the 40 patients was 16 years old while the oldest was 84 years old. Most of the patients were males (38 patients), while females were only 2 cases. In addition, most of the patients were ex-smokers (17; 42.5%), while 13(32.5%) were current smokers and only 10(25%) had no smoking history.
The maneuver was done for 27 cases with diffuse emphysema and 13 cases with bullae; 6 single bullae and 7 multiple bullae. The number of sessions differed from one case to another.16 cases had 1 session, 22 cases had 2 sessions and only 2 cases had 3 sessions. The maneuver was done unilaterally in 19 cases regardless the number of sessions. On the other hand, the maneuver was done bilaterally in 21 cases regardless the number of sessions.
There was significant improvement in the patients’ physical fitness appearing in 6MWT, highly significant improvement in FVC on contrast to FEV1, which showed numerical improvement, but this was statistically non significant. Also, there was no significant improvement in both PCO2 and PO2 after 3 months from the procedure. It was noticed that there was numerical improvement in RV, TLC and RV/TLC, but it was statistically non significant.
The most important achievement in this study was the highly significant improvement of MMRCD score after BLVR. 18 cases (45%) showed radiological changes 3 months after the procedure, most of them in the form of atelectasis, reflecting the reduction in the size of the bullae. Importantly, all patients were discharged from the hospital on the same day of BLVR treatment. No serious adverse events were observed except 1 patient died 3months after BLVR therapy by heart failure and ischemic heart disease. Adverse events were minor and transient, and most of them were likely attributable to the bronchoscope. They included cough, sore throat and common cold like symptoms.
from this study it was concluded that:
Bronchoscopic lung volume reduction therapy using histoacryl blue glue is well tolerated and safe in patients with advanced emphysematous bulla and diffuse emphysema. Treatment at diseased sites is associated with modest improvement in pulmonary function test values, increased exercise capacity and reduced dyspnea.