Javier García López, Paola Benedetti, Luis Puente Maestú and Javier de Miguel Díez.
The 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 of the Gregorio Maranon Hospital who have participated in a new Interhospital Pneumology Conference in Madrid, organized by Medical Writing.
During the meeting, sponsored by the Neumomadrid Foundation and with the collaboration of GSK Y Oximesa Nippon Gases, a review has been 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”, he has illustrated Paola Benedettia medical specialist at the Pneumology Service of the Gregorio Marañón Hospital, who has focused on the fundamentals and indications of these alternatives.
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, reduce hyperinflation improving respiratory mechanics and diaphragmatic muscle function. 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 all 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 persistence of the tobacco habit or treatment with prednisone, among others.
Regarding the types of lung volume reduction, the specialist highlighted valves for severe emphysema with intact fissuresand 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 careful selection of patientsthe 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, he 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 Maestu, head of the Pulmonology Service; Y Javier de Miguel Diez, Head of Section of the Pneumology Service; has also intervened Javier Garcia Lopezalso head of the Center’s Pulmonology Service Section, who has recounted the hospital’s experience with this technique through a clinical case that has illustrated how professionals work.
In this case it was a 71-year-old woman, ex-smoker, with a long-term COPD and that he had had two incomes 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 via CTan echocardio is performed with which it is not possible to estimate the pulmonary hypertension very concretely, recalls the specialist. 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, was placed three four-millimeter valves. All this just three months after he went to the consultation. After four days without immediate complications, he recalls, he was discharged. However, ten days after discharge, the patient went to the Emergency Department referring to a chest pain that, after carrying out a study, it was confirmed that it was a LSD atelectasisalthough his dyspnea had improved.
Since 2015, the specialist has 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 experience of the hospital, there has been a case of pneumothorax, a massive hemoptysis patient 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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