Clinical improvements after endoscopic lung volume reduction with valves in patients with advanced emphysema and a 6-min walk test ⩽140 m at baseline

Background Data regarding the effectiveness and safety of endoscopic lung volume reduction with valves (ELVR) in emphysema patients with a very low 6-min walk test (6MWT) are limited. Patients with severe emphysema and very low exercise capacity, as indicated by a 6MWT ⩽140 m, are often excluded from clinical studies on ELVR, assuming limited therapeutic benefits and increased complication risk. Study designs and methods This study utilised data from the Lungenemphysemregister e.V., a large German national multi-centre prospective open-label clinical trial, and aimed to assess the outcomes of ELVR in patients with a baseline 6MWT ⩽140 m and dyspnoea primarily attributed to hyperinflation. Results 54 patients with a baseline 6MWT ⩽140 m and 365 patients with a baseline 6MWT between 140 and 450 m were included in the study. Baseline characteristics were representative for patients with advanced lung emphysema. Patients with a 6MWT ⩽140 m at baseline had a lower forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide and higher symptom burden. In the 3-month follow-up, patients of both groups showed statistically significant improvements in lung function parameters, exercise capacity and quality of life parameters compared to baseline. Patients with a 6MWT ⩽140 m at baseline showed significantly more 6MWT improvement compared to patients with baseline 6MWT between 140 and 450 m. Moreover, complication rates were similar in both groups. Interpretation In summary, the data indicate that ELVR may be an effective and safe treatment for emphysema patients with a very low 6MWT of ⩽140 m if very limited exercise capacity is predominately caused by lung emphysema. Therefore future studies should include emphysema patients with a very low 6MWT.