Results of the CELEB (Comparative Effectiveness of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement) trial presented at the concluding day of European Respiratory Society Congress 2022 in Barcelona show no differences in outcomes following lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) among patients with emphysema.¹

Buttery et al compared the outcomes of lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) in this randomised-controlled single-blind superiority trial, which enrolled 88 patients with male preponderance (52%) and mean age of 64 years. There were 41 patients in the LVRS group and 47 in the BLVR group. The iBODE index composite score was used to evaluate the outcomes. The components of the iBODE index are body composition, airway obstruction, dyspnea and exercise capacity (incremental shuttle walk test).

At the end of the follow-up period of one year, the improvement in both intervention groups was equivalent as reflected by the i-BODE composite scores of -1.10 with LVRS and -0.82 with BLVR. The percentage predicted residual volume (RV% predicted) suggestive of air trapping in emphysema was -36.1 among patients who underwent LVRS versus -30.5 among those who underwent BLVR. Patient survival was also comparable with one death reported in each group.

This study designed as a superiority trial has for the first time compared the two interventions and concluded that the two procedures were comparable in outcomes (dyspnea, lung function and exercise capacity) and neither intervention was superior to the other with regard to safety and efficacy. Hence, not just clinicians, but patients with emphysema who are candidates for surgery, too can opt for BLVR in place of the more invasive lung volume reduction surgery as part of informed decision making. Noting these findings as “encouraging”, the authors, however, advocate the need for larger trials to further examine the safety and effectiveness of the two procedures.

 Reference

1. European Respiratory Society Congress 2022. Abstract RCT44448. Buttery S. Comparative effect of lung volume reduction surgery for emphysema and bronchoscopic lung volume reduction with valve placement: the CELEB trial. Presented September 6, 2022. https://img.medscapestatic.com/article/980/491/Abstract_LVRS_BLVRS.pdf.