Efficacy and safety of bronchoscopic lung volume reduction for chronic obstructive pulmonary disease: a systematic review and network meta-analysis

ABSTRACT

Background

Various bronchoscopic lung volume reduction (BLVR) methods have been developed to treat chronic obstructive pulmonary disease (COPD). The efficacy and safety of these interventions remain unclear. This study assessed the efficacy and safety of various BLVR interventions in COPD patients.

Methods:

PubMed and Embase were searched from inception to 21 October 2023. The primary outcomes assessed included the 6-min walking distance (6MWD), St. George Respiratory Questionnaire (SGRQ) score, lung function, and adverse events (AE). A frequentist approach with a random-effects model was used for a network meta-analysis.

Results:

Twelve randomized controlled trials (RCTs) with 1646 patients were included in this meta-analysis. Patients treated with an endobronchial valve (EBV) achieved a minimum clinically important difference (MCID) in 6MWD and SGRQ at 6 months. Patients treated with coils achieved MCID in the SGRQ score at 12 months. Patients with aspiration valve system and bronchoscopic thermal vapor ablation (BTVA) achieved MCID in the SGRQ score at 6 months.

Conclusions:

In COPD patients, EBV should be considered first, while being wary of pneumothorax. Coil and BTVA are potential therapeutic alternatives. Although BTVA demonstrates a safer procedural profile than coils, additional studies are imperative to clarify its efficacy.

KEYWORDS:

• Bronchoscopic lung volume reduction
• Chronic obstructive pulmonary disease
• Emphysema
• Network meta-analysis

Disclaimer

As a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.

Abbreviations

COPD, chronic obstructive pulmonary disease; BLVR, bronchoscopic lung volume reduction; EBV, endobronchial valve; SVS, spiration valve system; BTVA, bronchoscopic thermal vapor ablation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCT, randomized controlled trial; 6MWD, 6-minute walking distance; mMRC, modified Medical Research Council dyspnea grade; SGRQ, St. George Respiratory Questionnaire; AE, adverse events; GRADE, Grading of Recommendations Assessment, Development and Evaluation; OR, odds ratio; CI, confidence interval; WMD, weighted mean difference; SUCRA, surface under the cumulative ranking curve; FEV₁, forced expiratory volume in 1 second; RV, residual volume; LVRS, lung volume reduction surgery.

Declarations of Interest:

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures:

A reviewer on this manuscript has disclosed an institutional research grant from PulmonX and honoraria for lectures by PulmonX. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Data Availability Statement:

The review protocol is available on the PROSPERO website (Registration NO: CRD42023470437). All extracted data are available upon appropriate request by email to the co-corresponding authors.

Author Contributions:

G Hou and F Herth designed the study. R Zhang, Z Zheng, and Y Bian conducted the literature search and searched for relevant articles. Y Bian and M Deng contributed to the data extraction process. R Zhang and Z Zheng analyzed or interpreted the data. R Zhang and Z Zheng Verified underlying data. R Zhang and Z Zheng drafted the manuscript. All authors revised the manuscript and approved its final version. All authors had full access to all study data and accepted responsibility for the decision to submit for publication.

Additional information

Funding

This work was financially supported by National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01), National Natural Science Foundation of China (82300053), China Postdoctoral Science Foundation (2023M733987).