Treatment of advanced homogenous emphysema with endobronchial coils compared to NETT subjects who received LVRS or medical therapy

The National Emphysema Treatment Trial (NETT) demonstrated that LVRS added to maximal medical therapy (MT) was not beneficial in advanced homogenous emphysema leaving only lung transplantation or MT as viable therapeutic options. We hypothesized that bronchoscopic lung reduction using nitinol coils (LVRC) might be more effective than MT alone in patients with advanced homogenous emphysema. We examined 12-month outcomes in patients with advanced homogenous emphysema (bilateral LVRC vs. NETT subjects), matched by lung function and age. Lung function, survival, QOL and 6-minute walk distance (6MWD) were compared between LVRC, NETT MT and NETT LVRS groups. Data are reported as least squares means with IQR and analyzed using ANOVA. There were 85 LVRC (46%Men), 51 LVRS (47%Men), and 43 MT (67%Men) subjects with no difference in baseline FEV 1 % predicted (27.6±7.3%, 26.8±3.8%, 27.6±4.3% respectively). TLC (137.9±19.0%, 135.4±8.9%, 136.3±9.3%, p=0.34) was similar but baseline 6MWD (m) was lower in LVRC group (310.8±96.6, 371.4±84.1, 342.3±99.9, pl0.001). 12-month outcomes data (Table 1) shows that LVRC improved hyperinflation, air trapping and 6MWD compared to MT. 12-month survival was 96.4% (LVRC), 78.4% (LVRS) and 97.7% (MT). LVRC may be a useful treatment for patients with advanced homogenous emphysema.