Bronchoscopic lung volume reduction with valves: What should the internist know?

Abstract

Traditional therapies for emphysema such as bronchodilators and anti-inflammatory drugs have limited value due to permanent structural changes in the emphysematous lung that result in hyperinflation. Surgical lung volume reduction partially corrects hyperinflation by removing emphysematous lung and is an option in selected patients, but it carries a risk of morbidity and death. Valve therapy is a less-invasive option that involves bronchoscopic implantation of 1-way valves in emphysematous lung segments to allow air flow and mucus clearance in the direction of central airways. The authors review the rationale, evidence, and applications of valve therapy. KEY POINTS After valve placement, the 1-way flow gradually leads to selective de-aeration and collapse of treated areas, thus reducing hyperinflation. The US Food and Drug Administration has approved valve therapy for the treatment of emphysema. This procedure may work best for patients who have heterogeneous involvement and complete separation between affected and unaffected lobes.