Challenges and future directions of endobronchial valve (EBV) treatment
| Advanced patient selection | |
| Clinical patient characteristics | To define the cut-offs regarding clinical patient characteristics such as degree of obstruction, static hyperinflation, diffusion capacity, blood oxygen tension, exercise capacity, pulmonary hypertension, comorbidities, etc. for procedure-related risk estimation and efficacy outcome. |
| Emphysema severity | To define the exact role of quantitative lobar tissue destruction scores related to outcomes. |
| Prediction of collateral ventilation | To define the optimal cut-off (both lower and upper limit) for the degree of fissure integrity calculated on CT. |
| To establish the optimal method of measurement and interpretation of the Chartis system signal in the measurement of collateral ventilation. | |
| Prediction of response using quantification | To further develop quantitative HRCT software analysis with accurate assessment of fissure integrity, emphysema scores, the amount of air trapping and lung perfusion, all on a lobar level. |
| Multidisciplinary team | To establish a solid base for an emphysema multidisciplinary team like our lung cancer and ILD multidisciplinary team meetings. |
| Therapeutic challenges | |
| The positioning of LVRS versus EBV treatment | Not all patients that are good candidates for surgery are good candidates for valves and vice versa. |
| To create decision making guidance for candidate patients for both techniques. | |
| To create a step-up treatment guidance for initial good responders to EBV treatment. | |
| Closing the interlobar collateral channels | To develop treatments that successfully close the collateral channels which would significantly increase the patient population that could potentially benefit from EBV treatment. |
| Treatment decisions in patients with homogeneous disease | To identify the best treatment option for patients with real homogeneous disease. EBV treatment or coil treatment? |
| Granulation tissue | To identify predictors or risk factors for the development of granulation tissue after EBV treatment (and in fact after every implantable device in the human airways). |
| Burning questions | |
| Long-term effects | To establish the long-term efficacy, cost-efficiency, effect on exacerbations, hospitalisations, survival and adverse events. |
| The interaction with pulmonary rehabilitation. | The combination of EBV treatment and pulmonary rehabilitation could strengthen the effect of the EBV treatment. The best timing of the rehabilitation programme has not been investigated to date. |
| A look in the crystal globe | |
| Potential future developments | To develop new or customised valves. |
| To develop an advanced Chartis device that could be helpful in target lobe selection. | |
| To establish the role of advanced functional imaging with patient selection | |
| To combine different endoscopic and/or surgical techniques. |
LVRS: lung volume reduction surgery; CT: computed tomography; HRCT: high-resolution CT; ILD: interstitial lung disease.