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Effect of Bronchoscopic Lung Volume Reduction on Dynamic Hyperinflation and Exercise in Emphysema

Respiratory Muscle Laboratory, and Departments of Respiratory Medicine, Radiology, and Cardiothoracic Surgery, Royal Brompton Hospital; and Respiratory Muscle Laboratory, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London, United Kingdom

Correspondence and requests for reprints should be addressed to Nicholas Hopkinson, M.A., M.R.C.P., Respiratory Muscle Laboratory, Royal Brompton Hospital, Fulham Road, London SW3 6NP, UK. E-mail: n.hopkinson{at}ic.ac.uk

Endobronchial valve placement improves pulmonary function in some patients with chronic obstructive pulmonary disease, but its effects on exercise physiology have not been investigated. In 19 patients with a mean (SD) FEV₁ of 28.4 (11.9)% predicted, studied before and 4 weeks after unilateral valve insertion, functional residual capacity decreased from 7.1 (1.5) to 6.6 (1.7) L (p = 0.03) and diffusing capacity rose from 3.3 (1.1) to 3.7 (1.2) mmol · minute^–1 · kPa^–1 (p = 0.03). Cycle endurance time at 80% of peak workload increased from 227 (129) to 315 (195) seconds (p = 0.03). This was associated with a reduction in end-expiratory lung volume at peak exercise from 7.6 (1.6) to 7.2 (1.7) L (p = 0.03). Using stepwise logistic regression analysis, a model containing changes in transfer factor and resting inspiratory capacity explained 81% of the variation in change in exercise time (p < 0.0001). The same variables were retained if the five patients with radiologic atelectasis were excluded from analysis. In a subgroup of patients in whom invasive measurements were performed, improvement in exercise capacity was associated with a reduction in lung compliance (r² = 0.43; p = 0.03) and isotime esophageal pressure–time product (r² = 0.47; p = 0.03). Endobronchial valve placement can improve lung volumes and gas transfer in patients with chronic obstructive pulmonary disease and prolong exercise time by reducing dynamic hyperinflation.

Key Words: bronchoscopic lung volume reduction • chronic obstructive pulmonary disease • diaphragm • dynamic hyperinflation

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