Bronchoscopic lung volume reduction with endobronchial valves

Abstract

In the past 12 years, advancements in the treatment of lung emphysema have been intrinsically linked to interventional bronchoscopy. The present chapter will focus on the most studied bronchoscopic lung volume reduction (BLVR) technique, the endobronchial valve (EBV). The definition of the ideal candidate for BLVR with EBV has evolved to include aspects of fissure integrity (≤90%) in addition to emphysema gradient >15 pp. Collateral ventilation is currently recognized as a crucial factor directly linked to lung volume reduction. Together, dynamic air trapping and the absence of collateral ventilation indicate the cases in which valve treatment is more likely to succeed. Emphysema is a complex condition, and much remains to be learned regarding pathophysiology, phenotypes, pulmonary vascular bed, interlobar airflow, exercise, nutrition, and other aspects, including the quality of sleep in emphysema patients. In addition, efforts must be made to devise interventions that underscore the biopsychosocial well-being of these patients.