Publications
428 results found
Ratnakumar S, Madani Y, Aboelhassan S, et al., 2018, ADVANCED STAGE AND AGGRESSIVE CANCERS FORM A CONSIDERABLE PROPORTION OF LUNG MALIGNANCIES IN IDIOPATHIC PULMONARY FIBROSIS AND SCLERODERMA-ASSOCIATED ILD, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A146-A147, ISSN: 0040-6376
Evans R, Brutsche M, Busca R, et al., 2018, Quantifying patient centered outcomes associated with the use of bilateral endobronchial coil treatment in patients with severe emphysema, CURRENT MEDICAL RESEARCH AND OPINION, Vol: 34, Pages: 1927-1932, ISSN: 0300-7995
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- Citations: 1
Criner GJ, Sue R, Wright S, et al., 2018, A multicenter RCT of Zephyr® Endobronchial Valve treatment in heterogeneous emphysema (LIBERATE), American Journal of Respiratory and Critical Care Medicine, Vol: 198, Pages: 1151-1164, ISSN: 1073-449X
RATIONALE: This is the first multicenter RCT to evaluate effectiveness and safety of Zephyr® Endobronchial Valve EBV® out to 12-months. OBJECTIVES: To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation (CV) in the treated lobe. METHODS: Subjects were enrolled with a 2:1 randomization (EBV: Standard-of-Care (SoC)) at 24 sites. Primary outcome at 12-months was the ΔEBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of ≥15%. Secondary endpoints included absolute changes in post-BD FEV1, Six-Minute Walk Distance (6MWD), and St. George's Respiratory Questionnaire (SGRQ) scores. RESULTS: 190 subjects, 128 EBV and 62 SoC were randomized. At 12-months, 47.7% EBV and 16.8% SoC subjects had a ΔFEV1 ≥15% (p<0.001). ΔEBV-SoC at 12-months was statistically and clinically significant: for FEV1 (L), 0.106L (p<0.001); 6MWD, +39.31m (p=0.002); and SGRQ, -7.05 points (p=0.004). Significant ΔEBV-SoC were also observed in hyperinflation (RV, -522ml; p<0.001), mMRC, -0.8 points (p<0.001), and the BODE Index (-1.2 points). Pneumothorax was the most common serious adverse event in the Treatment Period (procedure to 45 days), in 34/128 (26.6%) of EBV subjects. Four deaths occurred in the EBV group during this phase, and one each in the EBV and SoC groups between 46 days and 12-months. CONCLUSIONS: Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea and quality of life out to at least 12-months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01796392.
Buttery S, Kemp S, Shah P, et al., 2018, The CELEB trial: Comparative effectiveness of lung volume reduction surgery for emphysema and bronchoscopic lung volume reduction with valve placement. A protocol for a randomised controlled trial, BMJ Open, Vol: 8, ISSN: 2044-6055
Introduction: Although lung volume reduction surgery and bronchoscopic lung volume reduction with endobronchial valves have both been shown to improve lung function, exercise capacity and quality of life in appropriately selected patients with emphysema, there are no direct comparison data between the two procedures to inform clinical decision making. Methods and Analysis: We describe the protocol of the CELEB study (ISRCTN19684749), a randomised controlled trial which will compare outcomes at 1 year between the two procedures, using a composite disease severity measure, the iBODE score, which includes body mass index, lung function, breathlessness and exercise capacity.Ethics and Dissemination: Ethical approval to conduct the study has been obtained from the Fulham Research Ethics Committee, London (16/LO/0286). The outcome of this trial will provide information to guide treatment choices in this population and will be presented at national and international meetings and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter.
D'Hooghe JNS, Goorsenberg AWM, Ten Hacken NHT, et al., 2018, Airway smooth muscle mass reduction after Bronchial Thermoplasty in asthmatics correlates with FEV1, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Slebos D-J, Wright S, Sue R, et al., 2018, Twelve-month positive outcomes of Zephyr endobronchial valves in severe emphysema patients: LIBERATE trial, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Slebos D-J, Shah P, Herth F, et al., 2018, A double-blind, randomized, sham-controlled study of Targeted Lung Denervation in patients with moderate to severe COPD, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 4
Herth FJF, Gompelmann D, Valipour A, et al., 2018, Removal of diseased emphysematous tissue with bronchoscopic thermal vapor ablation (BTVA), 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Garner J, Soni S, O'Dea K, et al., 2018, Late Breaking Abstract - Intra-alveolar neutrophil-derived microvesicles: a biomarker of COPD severity, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Singh S, 2018, Respiratory assessment for Driving, Essentials of Clinical Pulmonology, Editors: Shah, Publisher: CRC Press, ISBN: 9781498715799
Set at the level between the definitive reference work and the clinical manual, Essentials of Clinical Pulmonology is an invaluable cornerstone for all pulmonologists whether trainees or experienced clinicians.
Singh S, 2018, Preassessment for anaesthesia, Essentials of Clinical Pulmonology, Editors: Shah, Publisher: CRC Press, ISBN: 9781498715799
Set at the level between the definitive reference work and the clinical manual, Essentials of Clinical Pulmonology is an invaluable cornerstone for all pulmonologists whether trainees or experienced clinicians.
Gompelmann D, Shah PL, Valipour A, et al., 2018, Bronchoscopic thermal vapor ablation: best practice recommendations from an expert panel on endoscopic lung volume reduction, Respiration, Vol: 95, Pages: 392-400, ISSN: 1423-0356
Bronchoscopic thermal vapor ablation (BTVA) represents one of the endoscopic lung volume reduction (ELVR) techniques that aims at hyperinflation reduction in patients with advanced emphysema to improve respiratory mechanics. By targeted segmental vapor ablation, an inflammatory response leads to tissue and volume reduction of the most diseased emphysematous segments. So far, BTVA has been demonstrated in several single-arm trials and 1 multinational randomized controlled trial to improve lung function, exercise capacity, and quality of life in patients with upper lobe-predominant emphysema irrespective of the collateral ventilation. In this review, we emphasize the practical aspects of this ELVR method. Patients with upper lobe-predominant emphysema, forced expiratory volume in 1 second (FEV1) between 20 and 45% of predicted, residual volume (RV) > 175% of predicted, and carbon monoxide diffusing capacity (DLCO) ≥20% of predicted can be considered for BTVA treatment. Prior to the procedure, a special software assists in identifying the target segments with the highest emphysema index, volume and the highest heterogeneity index to the untreated ipsilateral lung lobes. The procedure may be performed under deep sedation or preferably under general anesthesia. After positioning of the BTVA catheter and occlusion of the target segment by the occlusion balloon, heated water vapor is delivered in a predetermined specified time according to the vapor dose. After the procedure, patients should be strictly monitored to proactively detect symptoms of localized inflammatory reaction that may temporarily worsen the clinical status of the patient and to detect complications. As the data are still very limited, BTVA should be performed within clinical trials or comprehensive registries where the product is commercially available.
Tremblay A, McFadden S, Bonifazi M, et al., 2018, Endobronchial ultrasound-guided transbronchial needle aspiration with a 19-G needle device, Journal of Bronchology and Interventional Pulmonology, Vol: 25, Pages: 218-223, ISSN: 1944-6586
Background: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is a well-established first-line minimally invasive modality for mediastinal lymph node sampling. Although results are excellent overall, the technique underperforms in certain situations. We aimed to describe our results using a new 19-G EBUS-guided transbronchial needle aspiration device to determine safety and feasibility of this approach.Methods: We completed a retrospective chart review of all cases performed to the time of data analysis at each of 3 study sites.Results: A total of 165 procedures were performed with a total of 297 individual lymph nodes or lesions sampled with the 19-G device by 10 bronchoscopists. Relatively large targets were selected for sampling with the device (mean lymph node size: 20.4 mm; lung lesions: 33.5 mm). A specific diagnosis was obtained in 77.3% of cases with an additional 13.6% of cases with benign lymphocytes, for a procedural adequacy rate of 90.9%. Procedure sample adequacy was 88.6% in suspected malignant cases, 91.0% in suspected sarcoidosis/lymphadenopathy cases, and 85.7% of cases with suspected lymphoma. On a per-node basis, a specific diagnosis was noted in 191/280 (68.2%) of samples, with an additional 61 showing benign lymphocytes for a per-node sample adequacy rate of 90%. One case (0.6%) of intraprocedure bleeding was noted.Conclusions: A new flexible 19-G EBUS needle was successfully and safely applied in a large patient cohort for sampling of lung and enlarged mediastinal lesions with high diagnostic rates across clinical indications.
Slebos D-J, Ten Hacken NH, Hetzel M, et al., 2018, Endobronchial coils for endoscopic lung volume reduction: best practice recommendations from an expert panel, Respiration, Vol: 96, Pages: 1-11, ISSN: 1423-0356
Endobronchial coils are an additional treatment option for lung volume reduction in patients with severe emphysema. Patient selection should be focused on patients with severe emphysema on optimal medical therapy and with evidence of severe hyperinflation. The technique is suitable in a broad range of patients with emphysema; however, patients with paraseptal emphysema, large focal (giant) bullae, significant co-morbidity and airway-predominant disease should be avoided. Treatment involves placing between 10 and 14 coils by bronchoscopy in the selected treatment lobe, with 2 lobes being treated sequentially. Lobe selection for treatment should be based on quantitative computed tomography, and the lobes with the greatest destruction should be targeted (excluding the right middle lobe). The treatment results in an improvement in pulmonary function, exercise performance and quality of life, particularly in patients with severe hyperinflation (residual volume > 200% predicted) and upper-lobe heterogeneous emphysema, but will also be of benefit in lower-lobe predominant and homogeneous emphysema. Finally, it has an acceptable safety profile, although special attention has to be paid to coil-associated opacity which is an inflammatory response that occurs in some patients treated with endobronchial coils.
Bonta PI, Chanez P, Annema JT, et al., 2018, Bronchial thermoplasty in severe asthma: best practice recommendations from an expert panel, Respiration, Vol: 95, Pages: 289-300, ISSN: 1423-0356
Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes
Shah PL, Herth FJF, 2018, Progress in Interventional Pulmonology, Respiration, Vol: 95, Pages: 287-288, ISSN: 1423-0356
Marchetti N, Kaufman T, Chandra D, et al., 2018, Endobronchial Coils Versus Lung Volume Reduction Surgery or Medical Therapy for Treatment of Advanced Homogenous Emphysema, CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION, Vol: 5, Pages: 87-96, ISSN: 2372-952X
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- Citations: 9
Fiorelli A, Santini M, Shah P, 2018, When can computed tomography-fissure analysis replace Chartis collateral ventilation assessment in the prediction of patients with emphysema who might benefit from endobronchial valve therapy?, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 26, Pages: 313-318, ISSN: 1569-9293
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- Citations: 10
Hetzel J, Maldonado F, Ravaglia C, et al., 2018, Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the Cryobiopsy Working Group on safety and utility and a call for standardization of the procedure, Respiration, Vol: 95, Pages: 188-200, ISSN: 1423-0356
Transbronchial cryobiopsies (TBCB) have recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases (DPLD). Despite a substantial and expanding body of literature, the technique has not yet been standardized and its place in the diagnostic algorithm of DPLD remains to be defined. In part, this reflects concerns over the diagnostic yield and safety of the procedure, together with the rapid spread of the technique without competency and safety standards; furthermore, there is a substantial procedural variability among centers and interventional pulmonologists. We report this expert statement proposed during the third international conference on “Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease” (Ravenna, October 27–28, 2016), which formulates evidence- and expert-based suggestions on the indications, contraindications, patient selection, and procedural aspects of the procedure. The following 5 domains were reviewed: (1) what is the role of TBCB in the diagnostic evaluation of DPLD: patient selection; (2) pathological considerations; (3) contraindications and safety considerations; (4) how should TBCB be performed and in what procedural environment; and (5) who should perform TBCB. Finally, the existence of white paper recommendations may also reassure local hospital credentialing committees tasked with endorsing an adoption of the technique.
Shah PL, Newsom-Davis T, 2018, Lung cancer, Essentials of Clinical Pulmonology, Pages: 328-353, ISBN: 9781498715799
Lung cancer is one of the commonest malignancies in males and in females, and although it is the fourth most common cause of cancer, it has the second highest death rate from a cancer. It accounts for 20% of all cancers in men, with a lifetime risk of 1 in 13, and 12% of all cancers in women, with a lifetime risk of 1 in 23. Worldwide lung cancer incidence is estimated at 1.6 million, with about 1, 095, 200 cases in males and 513, 600 in females. In 2008, there were 724, 300 new diagnoses in the developed world and 884, 500 new patients diagnosed with lung cancer in the developing world. The global burden of lung cancer has increased dramatically and reflects the smoking epidemic in the developing world.
Shah PL, Herth FJF, Lee YCG, et al., 2018, Essentials of Clinical Pulmonology, ISBN: 9781498715799
Concise yet comprehensive, this textbook of clinical pulmonology provides pulmonologists and respiratory disease physicians with all the key information that they need to know to manage the patient through the diagnosis and treatment journeys. From the most common condition to the rarest, each disease is consistently presented and comprehensively covered giving the reader just the key facts. Building upon the basic sciences and integrating these with clinical practice, each chapter has a consistent approach, is highly designed and visually appealing. Numerous illustrations, colour photographs, scans, bullet points, tables and algorithms ensure that the key information is available at a glance. The keynote sections serve as a useful revision aid as do the multiple choice questions. A truly international and highly experienced editorship with expert contributors from around the world ensure that the book remains a trusted source of information. Set at the level between the definitive reference work and the clinical manual, Essentials of Clinical Pulmonology is an invaluable cornerstone for all pulmonologists whether trainees or experienced clinicians.
Choy J, Shah PL, Pozniak A, 2018, Pulmonary complications of HIV infection, Essentials of Clinical Pulmonology, Pages: 425-436, ISBN: 9781498715799
The most recent estimates (2017) suggest that 37 million adults are living with the human immunodeficiency virus (HIV). Pulmonary complications from HIV disease is the major cause of morbidity and mortality, with 60% of affected individuals experiencing at least one significant HIV episode of pulmonary disease during their lifetime. Complications range from pulmonary infections especially from opportunistic infections to tumors to interstitial lung diseases. The alveolar macrophages are an important reservoir for HIV in the lung. Both cellular and humoral lung immunity is impaired in HIV. Individuals with mild immunosuppression typically develop more frequent respiratory infections than the normal population. There is also a greater prevalence of chronic obstructive pulmonary disease (COPD), lung cancer, interstitial lung disease, and pulmonary hypertension (PAH). Those with advanced, more profound immunosuppression tend to develop more opportunistic infections and opportunistic malignancies. The risk of these is dramatically reduced by treatment with antiretrovirals.
Burn P, Shah P, Hancock C, 2018, Flexible Ablation Device with Single Applicator Structure that Supports both Radiofrequency and Microwave Energy Delivery, IEEE/MTT-S International Microwave Biomedical Conference (IEEE-IMBioC), Publisher: IEEE
Burn P, Shah P, Hancock CP, 2018, Flexible Ablation Device with Single Applicator Structure that Supports both Radiofrequency and Microwave Energy Delivery, IEEE/MTT-S International Microwave Biomedical Conference (IEEE-IMBioC), Publisher: IEEE, Pages: 109-111
Cicenia JC, Hatipoglu US, Slebos D, et al., 2018, Coil Treatment and Quantitative CT Emphysema Measures: A Post Hoc Analysis of RENEW Trial Outcomes, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Criner GJ, Wright S, Sue R, et al., 2018, Effectiveness of the Zephyr® Endobronchial Valves (EBV®) in Patients with Severe Emphysema: Clinical Outcomes From LIBERATE, a Multicenter RCT, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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Gompelmann D, Gerovasili V, Kontogianni K, et al., 2018, Endoscopic Valve Removal >180 Days since Implantation in Patients with Severe Emphysema, RESPIRATION, Vol: 96, Pages: 348-354, ISSN: 0025-7931
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- Citations: 8
Colella S, Haentschel M, Shah P, et al., 2018, Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice, RESPIRATION, Vol: 95, Pages: 383-391, ISSN: 0025-7931
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- Citations: 52
Burn P, Shah P, Hancock C, 2018, Flexible Microwave Ablation Device with Integrated RF Cut Modality, 48th European Microwave Conference (EuMC), Publisher: IEEE, Pages: 336-339, ISSN: 2325-0305
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