Endobronchial Valves for Advanced Emphysema

The premise of lung-volume-reduction surgery (LVRS) is that resection of poorly functioning portions of emphysematous lung allows remaining lung function to improve. However, LVRS carries substantial morbidity, and only certain patient subgroups benefit (JW Gen Med Jun 3 2003). An analogous and less invasive procedure is bronchoscopic placement of one-way endobronchial valves that allow air to escape from, but not enter, hyperinflated lung segments (Figure). In this industry-sponsored randomized U.S. trial, 321 patients with advanced emphysema received endobronchial valves targeted to the most-involved lobe (mean valves per patient, 4) or standard care. Enrollment criteria included forced expiratory volume in 1 second (FEV₁) of 15% to 45% o…