An update on endobronchial valve therapy for severe emphysema: real world data and special indications.

Introduction: Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBV) is a guideline therapy for patients with severe emphysema without interlobar collateral ventilation, based on solid results from multiple randomized clinical trials (RCTs). However, whether its efficacy and safety in real-world clinical settings are comparable to those observed in RCTs has not been fully investigated. Additionally, recent reports on EBV therapy have focused on specialized populations (e.g. very low FEV₁, very low D_LCO) that were not represented in the RCTs.

Areas covered: We have summarized the efficacy and safety of the publications on BLVR with EBVs in real-world settings and in specialized populations, and have discussed these findings in relation to the RCTs data.

Expert opinion: The benefits of BLVR with EBVs have effectively translated into real-world clinical practice with a tolerable safety profile. These benefits and acceptable safety profile were also observed in specialized populations not fully represented in RCTs. We believe it is crucial to establish a nationwide registry in each country to keep track of outcome for quality and consistency, and to have a multidisciplinary COPD team discussion in each treating institution to keep on ensuring the successful clinical practice of BLVR with EBVs.