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DOI QR Code

중증 폐기종 환자에서 내시경적 폐용적 축소술의 임상 적용

Clinical Applications of Bronchoscopic Lung Volume Reduction for Patients with Severe Emphysema

  • 박태선 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이세원 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Park, Tai Sun (Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sei Won (Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2014.04.01

초록

Emphysema is a category of chronic obstructive pulmonary disease characterized by chronic airflow limitation and hyperinflation. Several decades ago, it was found that the surgical resection of emphysematous lung improved lung function and the long-term survival in patients with severe advanced emphysema. However, it was associated with substantial postoperative morbidity, such as persistent air-leak and mortality. Therefore, bronchoscopic lung volume reduction (BLVR) techniques have been developed to avoid these risks associated with surgery. Of these, endobronchial valves have been subject to the largest number of clinical trials. Endobronchial valves are unidirectional valves placed in the bronchus of the most hyperinflated lobe to block regional inflation, while allowing exhalation, leading to atelectasis of the target lobe. BLVR using endobronchial valves improves lung function, exercise tolerance, and symptoms. To obtain the maximum clinical benefits, it is important to select patients who have a complete lobar fissure and heterogeneous emphysematous lung involvement. Other bronchoscopic approaches are being developed to overcome these limitations.

키워드

참고문헌

  1. Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006;27:397-412. https://doi.org/10.1183/09031936.06.00025805
  2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442. https://doi.org/10.1371/journal.pmed.0030442
  3. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347-365. https://doi.org/10.1164/rccm.201204-0596PP
  4. Lee JH, Lee YK, Kim EK, et al. Responses to inhaled long-acting beta-agonist and corticosteroid according to COPD subtype. Respir Med 2010;104:542-549. https://doi.org/10.1016/j.rmed.2009.10.024
  5. Brantigan OC, Kress MB, Mueller EA. The surgical approach to pulmonary emphysema: 1961. Chest 2009;136(5 Suppl):e30. https://doi.org/10.1378/chest.09-2269
  6. Cooper JD, Patterson GA, Sundaresan RS, et al. Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J Thorac Cardiovasc Surg 1996;112:1319-1329. https://doi.org/10.1016/S0022-5223(96)70147-2
  7. Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003;348:2059-2073. https://doi.org/10.1056/NEJMoa030287
  8. Herth FJ, Gompelmann D, Ernst A, Eberhardt R. Endoscopic lung volume reduction. Respiration 2010;79:5-13. https://doi.org/10.1159/000256510
  9. Herth FJ, Noppen M, Valipour A, et al. Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort. Eur Respir J 2012;39:1334-1342. https://doi.org/10.1183/09031936.00161611
  10. Herth FJ, Eberhardt R, Gompelmann D, et al. Radiological and clinical outcomes of using Chartis$^{TM}$ to plan endobronchial valve treatment. Eur Respir J 2013;41:302-308. https://doi.org/10.1183/09031936.00015312
  11. Strange C, Herth FJ, Kovitz KL, et al. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction. BMC Pulm Med 2007;7:10. https://doi.org/10.1186/1471-2466-7-10
  12. Sciurba FC, Ernst A, Herth FJ, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 2010;363:1233-1244. https://doi.org/10.1056/NEJMoa0900928
  13. Valipour A, Herth FJ, Burghuber OC, et al. Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy. Eur Respir J 2014;43:387-396. https://doi.org/10.1183/09031936.00133012
  14. Venuta F, Anile M, Diso D, et al. Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J 2012;39:1084-1089. https://doi.org/10.1183/09031936.00071311
  15. Slebos DJ, Klooster K, Ernst A, Herth FJ, Kerstjens HA. Bronchoscopic lung volume reduction coil treatment of patients with severe heterogeneous emphysema. Chest 2012;142:574-582. https://doi.org/10.1378/chest.11-0730
  16. Shah PL, Slebos DJ, Cardoso PF, et al. Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial. Lancet 2011;378:997-1005. https://doi.org/10.1016/S0140-6736(11)61050-7
  17. Refaely Y, Dransfield M, Kramer MR, et al. Biologic lung volume reduction therapy for advanced homogeneous emphysema. Eur Respir J 2010;36:20-27. https://doi.org/10.1183/09031936.00106009