Transbronchial bullous volume reduction in COPD patients

Introduction: COPD patients with advanced disease achieve minimal or no control despite proper medical therapy that necessitates more radical approach. The bullae accentuate the altered elastic properties of the emphysematous lung and contribute to the expiratory flow limitation. Objective: The aim was to evaluate the therapeutic utility and safety of transbronchial volume reduction of emphysematous bullae in COPD patients. Patients & methods: At the site of entry, the air from the bulla was aspirated slowly, and then 10 cm of autologous blood was instilled into the bulla before the needle was withdrawn. Clinical, functional & radiological assessment of bulla volume and the incidence of adverse events were evaluated. Results: 12 male patients were enrolled in this study with mean age (±SD) 47 ± 5.6 years. The procedure was well tolerated and not associated with any serious complications. Improvements (clinically, functionally and radiologically) three months after the procedure were more obvious in patients with bullous volume <515 ml than in patients with bullous volume >515 ml. Conclusions: Intra-bullous blood instillation could be an effective and safe volume reduction technique of emphysematous bullae