Endobronchial valve improves patient-reported outcomes in emphysema with hyperinflation

Patients with hyperinflated emphysema experienced improvements in dyspnea, activity level and psychosocial parameters after undergoing lung volume reduction with an endobronchial valve, according to data published in the Annals of the American Thoracic Society.

In a post hoc analysis of the LIBERATE study, the researchers evaluated patient-reported outcomes of 190 patients with severe heterogeneous emphysema and hyperinflation with little or no collateral ventilation in the target lobe who had been randomly assigned 2:1 to undergo bronchoscopic lung volume reduction with Zephyr endobronchial valves (Pulmonx) or standard of care.

Changes in outcomes between groups were compared at 12 months. The researchers used the Traditional Dyspnea Index (TDI) focal score, COPD Assessment Test (CAT) regarding breathlessness on a hill or during activity, BORG scale of perceived exertion and Exacerbations of COPD Tool-Patient-Reported Outcome (EXACT-PRO) diary dyspnea domain to assess dyspnea; TDI magnitude of task, TDI magnitude of effort, TDI functional impairment, CAT question regarding limited activities and St. George’s Respiratory Questionnaire (SGRQ) activity domain to assess activity; and SGRQ impact domain and CAT questions regarding confidence and energy to assess psychosocial status.

At 12 months, significant improvements in SGRQ, CAT and TDI focal score were observed among patients treated with valves vs. standard of care. Notably, improvements in the “impacts” (P < .05) and “activity” (P < .001) domains drove improvements in SGRQ score, whereas improvements in breathlessness (P < .05), energy level (P < .05), activities (P < .001) and increased confidence when leaving home (P < .05) drove reductions in CAT, according to the data. Results also indicated improvements in measures of effort, task and functional impairment on the TDI (P < .001) as well as an improvement in the EXACT-PRO dyspnea domain.

In an analysis of the association between hyperinflation and the effectiveness of treatment on patient-reported outcomes, the researchers found clinically meaningful improvement in static hyperinflation at 12 months in the valve group, with reductions in residual volume and the ratio of residual volume to total lung capacity correlating with improvements in FEV₁, 6-minute walk distance, SGRQ total score and the EXACT-PRO dyspnea domain.

“Post hoc analysis of data from the LIBERATE study demonstrate that patients with severe emphysema and hyperinflation who achieve lung volume reductions following treatment with Zephyr valves experience ‘moderate’ to ‘large’ improvements in multidimensional scores for breathlessness, activity and psychosocial parameters that may permit reengagement in activities of daily living out to at least 12 months,” the researchers wrote. “The interruption of the downward spiral of symptom-induced inactivity, muscle deconditioning and ensuing weakness allows patients to experience improved activity, feeling of well-being, more confidence and a better quality of life.” – by Melissa Foster

Disclosures: This study was sponsored by Pulmonx. Dransfield reports he has served as consultant for and has received speakers fees and travel reimbursement from Pulmonx. Please see the study for all other authors’ relevant financial disclosures.