scholarly journals Effect of Bronchoscopic Lung Volume Reduction in Advanced Emphysema on Energy Balance Regulation

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Karin Sanders ◽  
Karin Klooster ◽  
Lowie E.G.W. Vanfleteren ◽  
Guy Plasqui ◽  
Anne-Marie Dingemans ◽  
...  
Keyword(s):  
Energy Balance ◽  
Lung Volume ◽  
Respiratory Mechanics ◽  
Volume Reduction ◽  
Fat Free Mass ◽  
Whole Body ◽  
Energy Requirements ◽  
Lung Volume Reduction ◽  
Clinical Trial Registry ◽  
The Impact

<b><i>Background:</i></b> Hypermetabolism and muscle wasting frequently occur in patients with severe emphysema. Improving respiratory mechanics by bronchoscopic lung volume reduction (BLVR) might contribute to muscle maintenance by decreasing energy requirements and alleviating eating-related dyspnoea. <b><i>Objective:</i></b> The goal was to assess the impact of BLVR on energy balance regulation. <b><i>Design:</i></b> Twenty emphysematous subjects participated in a controlled clinical experiment before and 6 months after BLVR. Energy requirements were assessed: basal metabolic rate (BMR) by ventilated hood, total daily energy expenditure (TDEE) by doubly labelled water, whole body fat-free mass (FFM) by deuterium dilution, and physical activity by accelerometry. Oxygen saturation, breathing rate, and heart rate were monitored before, during, and after a standardized meal via pulse oximetry and dyspnoea was rated. <b><i>Results:</i></b> Sixteen patients completed follow-up, and among those, 10 patients exceeded the minimal clinically important difference of residual volume (RV) reduction. RV was reduced with median (range) 1,285 mL (−2,430, −540). Before BLVR, 90% of patients was FFM-depleted despite a normal BMI (24.3 ± 4.3 kg/m<sup>2</sup>). BMR was elevated by 130%. TDEE/BMR was 1.4 ± 0.2 despite a very low median (range) daily step count of 2,188 (739, 7,110). Following BLVR, the components of energy metabolism did not change significantly after intervention compared to before intervention, but BLVR treatment decreased meal-related dyspnoea (4.1 vs. 1.7, <i>p</i> = 0.019). <b><i>Conclusions:</i></b> Impaired respiratory mechanics in hyperinflated emphysematous patients did not explain hypermetabolism. <b><i>Clinical Trial Registry Number:</i></b> NCT02500004 at www.clinicaltrial.gov.

Schweres Lungenemphysem: Zusammenhänge zwischen klinischen Verläufen nach bronchoskopischer Volumenreduktion und metabolischen Parametern erkennen

2021 ◽  
pp. 1-2
Author(s):  
Manfred Wagner
Keyword(s):  
Respiratory Mechanics ◽  
Fat Free Mass ◽  
Whole Body ◽  
Energy Requirements ◽  
Clinical Trial Registry ◽  
Doubly Labelled Water ◽  
Total Daily Energy Expenditure ◽  
Daily Step Count ◽  
Deuterium Dilution ◽  
The Impact

<b>Background:</b> Hypermetabolism and muscle wasting frequently occur in patients with severe emphysema. Improving respiratory mechanics by bronchoscopic lung volume reduction (BLVR) might contribute to muscle maintenance by decreasing energy requirements and alleviating eating-related dyspnoea. <b>Objective:</b> The goal was to assess the impact of BLVR on energy balance regulation. <b>Design:</b> Twenty emphysematous subjects participated in a controlled clinical experiment before and 6 months after BLVR. Energy requirements were assessed: basal metabolic rate (BMR) by ventilated hood, total daily energy expenditure (TDEE) by doubly labelled water, whole body fat-free mass (FFM) by deuterium dilution, and physical activity by accelerometry. Oxygen saturation, breathing rate, and heart rate were monitored before, during, and after a standardized meal via pulse oximetry and dyspnoea was rated. <b>Results:</b> Sixteen patients completed follow-up, and among those, 10 patients exceeded the minimal clinically important difference of residual volume (RV) reduction. RV was reduced with median (range) 1,285 mL (–2,430, –540). Before BLVR, 90% of patients was FFM-depleted despite a normal BMI (24.3 ± 4.3 kg/m2). BMR was elevated by 130%. TDEE/BMR was 1.4 ± 0.2 despite a very low median (range) daily step count of 2,188 (739, 7,110). Following BLVR, the components of energy metabolism did not change significantly after intervention compared to before intervention, but BLVR treatment decreased meal-related dyspnoea (4.1 vs. 1.7, <i>p</i> = 0.019). <b>Conclusions:</b> Impaired respiratory mechanics in hyperinflated emphysematous patients did not explain hypermetabolism. <b>Clinical Trial Registry Number:</b> NCT02500004 at www.clinicaltrial.gov.

The Impact of Nutritional Status on the Outcome of Lung Volume Reduction Surgery

CHEST Journal ◽  
1999 ◽  
Vol 116 (3) ◽  
pp. 693-696 ◽  
Author(s):  
Peter Mazolewski ◽  
J.F. Turner ◽  
Mindy Baker ◽  
Terry Kurtz ◽  
Alex G. Little
Keyword(s):  
Nutritional Status ◽  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
The Impact

Endoscopic Lung Volume Reduction in COPD: The Impact of Coil Implantation on Patients’ Physical Activity

Respiration ◽  
2019 ◽  
Vol 99 (2) ◽  
pp. 177-180
Author(s):  
Leonie Biener ◽  
Dirk Skowasch ◽  
Sophia Hollmann ◽  
Tina Schreiber ◽  
Georg Nickenig ◽  
...  
Keyword(s):  
Physical Activity ◽  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
The Impact

scholarly journals Endobronchial Valve (Zephyr) Treatment in Homogeneous Emphysema: One-Year Results from the IMPACT Randomized Clinical Trial

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Ralf Eberhardt ◽  
Dirk-Jan Slebos ◽  
Felix J.F. Herth ◽  
Kaid Darwiche ◽  
Manfred Wagner ◽  
...  
Keyword(s):  
Lung Volume ◽  
Standard Of Care ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Serious Adverse Events ◽  
Bode Index ◽  
Clinical Benefits ◽  
The Mean ◽  
The Impact ◽  
Collateral Ventilation

<b><i>Rationale:</i></b> The long-term safety and effectiveness of bronchoscopic lung volume reduction with Zephyr endobronchial valves in subjects with severe homogeneous emphysema with little to no collateral ventilation beyond 3 months have yet to be established. <b><i>Methods:</i></b> Ninety-three subjects were randomized to either bronchoscopic lung volume reduction with Zephyr valves or standard of care (SoC) (1:1). Zephyr valve subjects were assessed at 3, 6, and 12 months. SoC subjects were assessed at 3 and 6 months; they were then offered crossover to Zephyr valve treatment. <b><i>Results:</i></b> The mean group difference (Zephyr valve – SoC) for change in FEV<sub>1</sub> from baseline to 6 months was 16.3 ± 22.1% (mean ± SD; <i>p</i> &#x3c; 0.001). Secondary outcomes showed the mean between-group difference for the six-minute walk distance of +28.3 ± 55.3 m (<i>p</i> = 0.016); St. George’s Respiratory Questionnaire, −7.51 ± 9.56 points (<i>p</i> &#x3c; 0.001); modified Medical Research Council, −0.42 ± 0.81 points (<i>p</i> = 0.019); BODE index, −0.85 ± 1.39 points (<i>p</i> = 0.006); and residual volume of −430 ± 830 mL (<i>p</i> = 0.011) in favor of the Zephyr valve group. At 6 months, there were significantly more responders based on the minimal clinically important difference for these same measures in the Zephyr valve versus the SoC group. The clinical benefits were persistent at 12 months. The percentage of subjects with respiratory serious adverse events was higher in the Zephyr valve group compared to SoC during the first 30 days post-procedure but not statistically different for the Zephyr valve and SoC groups from 31 days to 6 months, and stable in the Zephyr valve group out to 12 months. There were 2 deaths in the SoC group in the 31-day to 6-month period and none in the Zephyr valve group out to 12 months. <b><i>Conclusions:</i></b> Bronchoscopic lung volume reduction with Zephyr valves in subjects with severe homogeneous emphysema and little to no collateral ventilation provides clinically meaningful change from baseline in lung function, quality of life, exercise capacity, dyspnea, and the BODE index at 6 months, with benefits maintained out to 12 months.

scholarly journals CT-derived muscle remodelling after bronchoscopic lung volume reduction in advanced emphysema

Thorax ◽  
2018 ◽  
Vol 74 (2) ◽  
pp. 206-207 ◽  
Author(s):  
Karin J C Sanders ◽  
Karin Klooster ◽  
Lowie E G W Vanfleteren ◽  
Dirk-Jan Slebos ◽  
Annemie M W J Schols
Keyword(s):  
Skeletal Muscle ◽  
Muscle Mass ◽  
Lung Volume ◽  
Respiratory Mechanics ◽  
Mass Gain ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Walk Distance ◽  
Registration Number ◽  
Muscle Remodelling

Muscle wasting frequently occurs in severe emphysema. Improving respiratory mechanics by bronchoscopic lung volume reduction using endobronchial valves (EBV) might prevent further loss or even increase in muscle mass. CT-derived skeletal muscle mass gain was observed in 39/49 patients 6 months after EBV. Multiple linear regression showed that gain in muscle (β=2.4; 95% CI 0.2 to 4.6; p=0.036) and intramuscular fat (β=3.1; 95% CI 0.2 to 5.9; p=0.035) is associated with improved 6 min walk distance independent of the change in residual volume. Skeletal muscle remodelling associates with improved exercise capacity after EBV, independent of hyperinflation reduction.Trial registration numberClinical trial registered with the Dutch trial register www.trialregister.nl (NTR2876), Results.

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