COPD Life Expectancy and Bronchoscopic Lung Volume Reduction

Undergoing bronchoscopic lung volume reduction (BLVR) may lengthen the usual shortened life expectancy of patients with chronic obstructive pulmonary disease (COPD) and severe lung hyperinflation. This was among study findings published recently in Respiratory Medicine.

According to current guidelines, treatment for patients with hyperinflated lung volumes in COPD involves BLVR with lung volume reduction coils or endobronchial valves (EBV), which have proven to significantly improve heart function, the ability to exercise, and quality of life. However, few studies have delved into the impact of BLVR on life expectancy. Researchers therefore sought to investigate the difference in survival rate between patients with COPD receiving BLVR treatment vs patients with COPD who do not receive BLVR treatment.

To accomplish this, they conducted an observational study of 1471 patients (mean age, 61 years; 63% female), which included patients with COPD who visited University Medical Centre Groningen, the Netherlands, between June 2006 and July 2019 and received pulmonary function tests. An overwhelming majority were long-term smokers (mean 40±19 years). A total of 483 of these patients were treated with BLVR (73% with EBV, 27% with coils). Notably, patients in the treated cohort had worse pulmonary function and more frequent comorbid event histories of heart attack, stroke, or percutaneous coronary intervention than patients who were not treated. 

During follow-up, 531 patients died (median time to death 1077 days, range 2-4185 days after consultation). Of the patients who died, 165 were in the BLVR cohort. Total population median survival time was 2694 days (95% CI, 2462-2926). Patients treated with BLVR survived significantly longer than patients not treated with BLVR (median survival 3133 days [95% CI, 2777-3489] vs 2503 days [95% CI, 2281-2725); P <.001). Moreover, after adjusting for other influencing factors (including gender, age, packyears, lung function measures, emphysema destruction score, airway wall thickness, stroke history, and heart health), BLVR was found to be an independent predictor of survival.

Researchers concluded, “Our results suggest that bronchoscopically reducing lung volume in patients with severe hyperinflation may lead to a survival benefit for a population with a severely reduced life expectancy.” Study limitations involved selection bias of the control group which included patients not eligible for BLVR and investigator lack of awareness of other medical events, therapies, or causes of death which could directly impact results during the follow-up period.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Hartman JE, Welling JBA, Klooster K, Carpaij OA, Augustijn SWS, Slebos DJ. Survival in COPD patients treated with bronchoscopic lung volume reduction. Respir Med. Published online March 16, 2022. doi:10.1016/j.rmed.2022.106825