Javier García López, Paola Benedetti, Luis Puente Maestú and Javier de Miguel Díez.
Volume reduction in chronic obstructive pulmonary disease (COPD) is “effective in all its variants”. However, it requires an exhaustive study of the patients who can benefit from these treatments, as highlighted by the pulmonologists at Hospital Gregorio Marañón who have participated in a new Interhospital Conference on Pulmonology in Madridorganized by Medical Writing.
During the meeting, sponsored by the Neumomadrid Foundation and with the collaboration of GSK and Oximesa Nippon Gases, a review was made of the therapeutic options for patients with severe COPD, whose daily habits are limited. “The patient expresses that great sensation of lack of air and of having to breathe very superficially”, has illustrated Paola Benedetti, specialist doctor of the Pulmonology Service of the Gregorio Marañón Hospital, who has focused on the fundamentals and indications of these alternatives.RELATED
Discussion table on volume reduction in severe COPD.
The main objective, the expert has highlighted, is to “help a little more” the patient, that is, to reduce hyperinflation by improving respiratory mechanics and the function of the diaphragmatic muscle. Also, improving the elastic retraction of the lung, favoring the gas exchange capacity of the remaining lung tissue or reversing the chronic decrease in oxygen supply to the tissues.
Like any therapy, Beneditti has warned, volume reduction has indications and contraindications. Among the first is that it is a patient with severe emphysema, with “very significant” dyspnea or that it meets certain functional criteria. Among the contraindications, on the other hand, we find having bronchiectasis or cancer, as well as the persistence of smoking or treatment with prednisone, among others.
Regarding the types of lung volume reduction, the specialist has highlighted the valves for severe emphysema with complete fissures, and steam in severe emphysema with communicated fissures.
One of the fundamental advantages of the valves, the pulmonologist has underlined, is that they are reversible, while steam “is not a reversible option”. At this point, the expert has pointed out the speed with which this technique is applied, not exempt from possible complications such as dyspnea, fever or acute pneumonitis.
“Something essential is the careful selection of patients, the main filter for the indication for these therapies”, remarked the specialist, who has emphasized that it is necessary to “offer a benefit above the risks”. Another important aspect, she added, “is that there is no age limit and it does not interfere with the lung transplant”.
Javier García López, Paola Benedetti during the Interhospital Conference on Pulmonology.
Cashew experience in volume reduction in COPD
At the table, moderated by Luis Puente Maestú, head of the Pneumology Service; and Javier de Miguel Díez, head of the Pneumology Service Section; Javier García López, also head of the Center’s Pneumology Service Section, has also spoken, who has recounted the hospital’s experience with this technique through a clinical case with which he has illustrated how professionals work.
In this case, it was a 71-year-old woman, an ex-smoker, with long-term COPD and who had had two admissions in the last three years. With her, and with any patient, “the possible causes of exclusion must be exhaustively assessed”, explained García, emphasizing that “the patient must know the risks before deciding if he wants to be treated”.
After evaluating the emphysema through CT, an echocardio is performed with which pulmonary hypertension cannot be estimated in a very specific way, the specialist recalls. At this point, he highlights that one of the contraindications, pulmonary hypertension, is the only one that exists for the patient, so “you have to go further and do a catheterization”, where the pulmonologists confirm that it is not severe or moderate, so you can continue with the treatment.
“Knowing that it is a candidate, we have to choose how we treat it: whether with valves or steam,” says the specialist. “We always prefer valves because it’s reversible if complications occur,” he adds. The patient, he recalls, had three four-millimeter valves placed. All this just three months after she came to the consultation. After four days with no immediate complications, she recalls, she was discharged. However, ten days after her discharge, the patient went to the Emergency Department reporting chest pain that, after performing a study, confirmed that it was LSD atelectasis, although her dyspnea had improved.
Since 2015, the specialist recalled, the hospital has treated 21 patients through Coils, valves and steam; with subjective improvement in 80 percent of patients, even at 5 years. However, these procedures “are not free”, as Garcia has underlined, so they are associated with risks. In the hospital’s experience, there has been one case of pneumothorax, one patient with massive hemoptysis, and three patients with serious infections. However, “volume reduction is effective in all its variants”, the pulmonologist stressed, pointing out the need to carry out an “exhaustive study” of each case as they are very fragile patients.
Javier de Miguel Díez, Luis Puente Maestú, Paola Benedetti and Javier García López.
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