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Endobronchial Coils in Patients with Severe Emphysema

JAMA; ePub 2016 May 15; Sciurba, Criner, et al

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The use of endobronchial coils compared with usual care resulting in improvement in median exercise tolerance was observed among patients with emphysema and severe hyperinflation; however, this improvement was of uncertain clinical importance and with a higher likelihood of major complications. This according to a study of 315 patients (mean age 64 years) with emphysema and severe air trapping and randomly assigned to continue usual care alone (n=157) vs usual care plus bilateral coil treatment (n=158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. Researchers found:

• Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care.

• Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (OR=1.8).

• Between-group difference in median change in FEV1 was 7.0%, and the between group St. George’s Respiratory Questionnaire scored improved -8.9 points, each favoring the coil group.

• Major complications occurred in 34.8% of coil participants vs 19.1% of usual care.

Citation: Sciurba FC, Criner GJ, Strange C, et al. Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema. The RENEW Randomized Clinical Trial. [Published online ahead of print May 15, 2016]. JAMA. doi:10.1001/jama.2016.6261.

Commentary: Typically patients with COPD receive treatment beginning with short acting bronchodilators, then long-acting bronchodilators, combination bronchodilator/inhaled steroids, and PDE-4 inhibitors. The specific medications depend upon the severity of disease as measured by symptoms, risk of future exacerbations, and FEV-1 on spirometry. It is helpful to be aware that additional therapies are also being evaluated for selected patients with severe COPD. Lung reduction surgery has been shown to improve lung function and quality of life in patients with advanced upper lobe emphysema.1 One-way valves have also been studied for upper lobe emphysema. This study evaluated endobronchial coils, which work by compressing emphysematous tissue and improving elasticity in adjacent lung tissue. All are options that are being evaluated and for which careful patient selection is paramount in decisions about treatment. —Neil Skolnik, MD

1. Fishman A, Martinez F, Naunheim K, et al. National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348(21):2059-2073.

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