Endobronchial coil treatment in severe emphysema patients with alpha-1 antitrypsin deficiency

Int J Chron Obstruct Pulmon Dis. 2018 Nov 5;13:3645-3649. doi: 10.2147/COPD.S176366. eCollection 2018.

Abstract

Endobronchial coil treatment (ECT) is a minimally invasive procedure developed for palliative care of patients with severe emphysema. ECT has demonstrated a decrease in hyperinflation, an improvement in quality of life, and an acceptable safety profile in randomized controlled trials (RCTs). Because alpha-1 antitrypsin deficiency (AATD) is a classical exclusion criterion in RCTs, there is no available data for ECT in AATD. In this post hoc analysis of the REVOLENS study (Réduction volumique endobronchique par spirales; ClinicalTrials.gov Identifier: NCT01822795), a multicenter 1:1 RCT which compared bilateral ECT with usual care in severe emphysema, we analyzed the efficacy and safety results at 1 year in six patients with AATD (five males, one female; mean age: 52±9 years) who underwent ECT. A significant decrease in hyperinflation (0.35 L decrease in residual volume [RV]) was observed in four out of six patients at 6 months and three out of six patients at 12 months, and an improvement in quality of life (improvement of 4 points in the St George's Respiratory Questionnaire [SGRQ]) was observed in four out of six patients at both 6 and 12 months. Efficacy results at 6 and 12 months from the six AATD patients were compared with 84 non-AATD patients who underwent ECT, and no statistically significant differences were found for FEV1, RV, 6MWT score and SGRQ score. Respiratory-related serious adverse event was limited to pneumonia in one AATD patient at 1 year post-ECT. This post hoc study suggests that AATD patients may have similar efficacy and safety outcomes at 1 year as non-AATD patients. Because of the paucity of available data, appropriately powered studies are needed to determine the effects of ECT in AATD.

Keywords: COPD; bronchoscopy; interventional; volume reduction.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bronchoscopy / adverse effects
  • Bronchoscopy / instrumentation*
  • Cross-Over Studies
  • Equipment Design
  • Exercise Tolerance
  • Female
  • Forced Expiratory Volume
  • France
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Pulmonary Emphysema / diagnosis
  • Pulmonary Emphysema / physiopathology
  • Pulmonary Emphysema / therapy*
  • Quality of Life
  • Recovery of Function
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • alpha 1-Antitrypsin Deficiency / diagnosis
  • alpha 1-Antitrypsin Deficiency / physiopathology
  • alpha 1-Antitrypsin Deficiency / therapy*

Supplementary concepts

  • alpha-1-Antitrypsin Deficiency, Autosomal Recessive

Associated data

  • ClinicalTrials.gov/NCT01822795