Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves.

Abstract

INTRODUCTION:

Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) has emerged as an important treatment method for patients with severe chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are a frequent complication following BLVR with EBV. However, there is no consensus on the prevention of AECOPD.

OBJECTIVES:

Our study aims to compare the outcomes of different prophylactic measures on the occurrence of AECOPD after BLVR with EBV.

METHODS:

We conducted a multicenter, retrospective study of patients who underwent BLVR with EBV at six different institutions. Emphasis was directed towards the specific practices aimed at preventing AECOPD: antibiotics, steroids, antibiotics plus steroids, or no prophylaxis. Subgroups were compared, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated.

RESULTS:

A total of 170 patients were reviewed. The rate of AECOPD was 21.2% for the full cohort. Patients who received prophylaxis had a significantly lower rate of AECOPD compared with those who did not (16.7% vs. 46.2%; p = 0.001). The rate was lowest in patients who received antibiotics alone (9.2%). There was no significant difference in the rate of AECOPD between patients who received steroids alone or antibiotics plus steroids, compared with the other subgroups. The OR for AECOPD was 4.3 (95% CI: 1.8-10.4; p = 0.001) for patients not receiving prophylaxis and 3.9 (95% CI: 1.5-10.1; p = 0.004) for prophylaxis other than antibiotics alone.

CONCLUSIONS:

Administration of antibiotics after BLVR with EBV was associated with a lower rate of AECOPD. This was not observed with the use of steroids or in combination with antibiotics.

• Authors: David Abia-Trujillo, Alejandra Yu Lee-Mateus, Juan C Garcia-Saucedo, Omran Saifi, Neal M Patel, Felix J F Herth, John R Woytanowski, Ihab Alshelli, Sajive Alevas, Juan P Uribe Becerra, Adnan Majid, Eric S Edell, Megan M Dulohery-Scrodin, Janani S Reisenauer, Hiren J Mehta, Michael A Jantz, Hawazin K Abbas, Sebastian Fernandez-Bussy
• Journal: The clinical respiratory journal (Clin Respir J) Vol. 16 Issue 1 Pg. 43-48 (Jan 2022) ISSN: 1752-699X [Electronic] England
• PMID: 34605606 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Disease Progression
• Humans
• Pneumonectomy
• Pulmonary Disease, Chronic Obstructive (complications, drug therapy, epidemiology)
• Retrospective Studies