German IQWiG has published the final report of assessment of methods for lung volume reduction in severe emphysema

In 2014, Joint Federal Committee commissioned Institute for Quality and Efficiency in Health Care (IQWiG) to conduct health technology assessment of different approaches for lung volume reduction (LVR) in patients with severe pulmonary emphysema. And now IQWiG published final report of the study that aimed to evaluate benefit of a treatment with a surgical or bronchoscopic procedure for LVR compared to a conservative treatment in patients with severe pulmonary emphysema. Following bronchoscopic LVR techniques were evaluated:

• LVR with valves
• LVR with spirals
• LVR with polymer foam
• LVR with airway bypass stent
• LVR with thermal vapor ablation

Within evaluation outcomes listed below were considered for each technique:

• Overall mortality
• Cardiovascular morbidity and mortality
• COPD symptoms
• Exacerbations
• Exercise capacity
• More adverse effects and complications of therapy
• Hospital stay
• Psychological symptoms (depression, for example, anxiety)
• Cognitive skills
• Health-related quality of life

Available data of efficacy and safety for surgical and single bronchoscopic procedures showed advantages and disadvantages in comparison with standard therapy alone. Thus, some interventions can increase physical resilience or quality of life. However, there are also negative effects. For instance, there is at least a higher mortality in the short-term period after surgical LVR. At the same time, exacerbations or pneumothorax can occur after the bronchoscopic LVR.

As the results of the study it was stated that comparison of surgical and bronchoscopic procedures for LVR is not yet possible due to lack of evidence.

However, currently ongoing studies comparing surgical and bronchoscopic LVR with valves, will deliver first results in 2019, so more definite conclusion can be made about relative effectiveness and safety of the methods.

See full report in German here.

See press release in German here.

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