Endobronchial coil treatment in severe emphysema patients with alpha-1 antitrypsin deficiency

Jeanne Marie Perotin (1) , Sylvie Leroy (2) , Charles Hugo Marquette (2) , Hervé Mal (3, 4) , Hervé Dutau (5) , Arnaud Bourdin (6, 7) , Jean Michel Vergnon (8) , Christophe M. Pison (9, 10, 11) , Coralie Barbe (1) , Gaetan Deslée (12, 1)

1 CHU Reims - Hôpital universitaire Robert Debré [Reims]
2 CHU - Hôpital Pasteur [Nice]
3 Service de pneumologie B
4 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
5 APHM - Assistance Publique - Hôpitaux de Marseille
6 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
9 Département de médecine aiguë spécialisée
10 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
11 LBFA - Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée
12 Hôpital Maison Blanche

Endobronchial coil treatment (ECT) is a minimally invasive procedure developed for palliative care of patients with severe emphysema. ECT has demonstrated a decrease in hyperinflation, an improvement in quality of life, and an acceptable safety profile in randomized controlled trials (RCTs). Because alpha-1 antitrypsin deficiency (AATD) is a classical exclusion criterion in RCTs, there is no available data for ECT in AATD. In this post hoc analysis of the REVOLENS study (Réduction volumique endobronchique par spirales; ClinicalTrials.gov Identifier: NCT01822795), a multicenter 1:1 RCT which compared bilateral ECT with usual care in severe emphysema, we analyzed the efficacy and safety results at 1 year in six patients with AATD (five males, one female; mean age: 52±9 years) who underwent ECT. A significant decrease in hyperinflation (0.35 L decrease in residual volume [RV]) was observed in four out of six patients at 6 months and three out of six patients at 12 months, and an improvement in quality of life (improvement of 4 points in the St George's Respiratory Questionnaire [SGRQ]) was observed in four out of six patients at both 6 and 12 months. Efficacy results at 6 and 12 months from the six AATD patients were compared with 84 non-AATD patients who underwent ECT, and no statistically significant differences were found for FEV1, RV, 6MWT score and SGRQ score. Respiratory-related serious adverse event was limited to pneumonia in one AATD patient at 1 year post-ECT. This post hoc study suggests that AATD patients may have similar efficacy and safety outcomes at 1 year as non-AATD patients. Because of the paucity of available data, appropriately powered studies are needed to determine the effects of ECT in AATD.

Mots clés: interventional; bronchoscopy; volume reduction; COPD

Domaines: Pneumologie et système respiratoire

Jeanne Marie Perotin, Sylvie Leroy, Charles Hugo Marquette, Hervé Mal, Hervé Dutau, et al.. Endobronchial coil treatment in severe emphysema patients with alpha-1 antitrypsin deficiency. International Journal of Chronic Obstructive Pulmonary Disease, 2018, 13, pp.3645-3649. ⟨10.2147/COPD.S176366⟩. ⟨hal-01933038⟩