Publications
428 results found
Kemp SV, Zoumot Z, Shah PL, 2016, Three-Year Follow-Up of a Patient with a Giant Bulla Treated by Bronchoscopic Intrabullous Autologous Blood Instillation, RESPIRATION, Vol: 92, Pages: 283-284, ISSN: 0025-7931
Kemp SV, Herth FJF, Shah PL, 2016, Bullectomy: A Waste of Space or Room for Improvement?, Respiration, Vol: 92, Pages: 218-219, ISSN: 1423-0356
Valipour A, Gompelmann D, Shah P, et al., 2016, Volume changes after segmental vapor ablation and associated improvements in FEV<sub>1</sub>, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Sczaniecka A, Gonzalez X, Zuccatosta L, et al., 2016, A novel flexible 19G EBUS-TBNA needle: Absolute and relative performance in patients, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Herth FJF, Shah P, Valipour A, et al., 2016, STEP-UP randomized controlled trial of vapor ablation in patients with severe emphysema: 12 month results, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Slebos D-J, Shah P, Criner G, et al., 2016, LATE-BREAKING ABSTRACT: The RENEW trial: Predictors of effectiveness of endobronchial coil therapy in patients with advanced emphysema, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Egan JJ, Gompelmann D, Shah PL, et al., 2016, Targeted segmental volume reduction with vapor ablation in emphysema results in reduced RV and clinically meaningful improvement (CMI) in FEV<sub>1</sub>, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Hopkinson N, Kemp S, Toma T, et al., 2016, Survival benefit from successful bronchoscopic lung volume reduction with endobronchial valves - A 10 year follow up study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Shah PL, Gompelmann D, Valipour A, et al., 2016, Thermal vapour ablation to reduce segmental volume in patients with severe emphysema: STEP-UP 12 month results., Lancet Respir Med, Vol: 4, Pages: e44-e45
Palamidas AF, Rosendahl U, Shah PL, 2016, Endobronchial Ultrasound Bronchoscopy to the Heart of the Matter, Respiration, Vol: 92, Pages: 127-130, ISSN: 1423-0356
Endobronchial ultrasound has been one of the success stories of the last decade, and the utility of the procedure continues to expand. Originally, it was developed for the staging and diagnosis of lung cancer, but its use rapidly expanded to other malignancies and even benign disease. We present the case of a patient originally referred with suspected endocarditis who was found to have a mass involving the right ventricle and the pulmonary outflow tract. Endobronchial ultrasound-guided biopsy was used to obtain a tissue diagnosis from the cardiac mass.
Garner J, Kemp SV, Toma TP, et al., 2016, Survival after endobronchial valve placement for emphysema: a 10-Year follow-up study, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 519-521, ISSN: 1535-4970
Sciurba FC, Criner GJ, Strange C, et al., 2016, Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema the RENEW randomized clinical trial, Journal of the American Medical Association, Vol: 315, Pages: 2178-2189, ISSN: 0002-9955
Importance Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation.Objective To determine the effectiveness and safety of endobronchial coil treatment.Design, Setting, and Participants Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015.Interventions Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung.Main Outcomes and Measures The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George’s Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications.Results Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs −7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.
Slebos D-J, Shah PL, 2016, Go with the Flow: The Importance of the Assessment of Collateral Ventilation in Endobronchial Valve Treatment, Respiration, Vol: 91, Pages: 269-270, ISSN: 1423-0356
Kemp SV, Shah PL, 2016, An update on bronchoscopic treatments for chronic obstructive pulmonary disease, CURRENT OPINION IN PULMONARY MEDICINE, Vol: 22, Pages: 265-270, ISSN: 1070-5287
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- Citations: 2
Harzheim D, Sterman D, Shah PL, et al., 2016, Bronchoscopic Transparenchymal Nodule Access: Feasibility and Safety in an Endoscopic Unit, Respiration, Vol: 91, Pages: 302-306, ISSN: 1423-0356
Background: The minimal invasive investigation of solitary pulmonary nodules becomes increasingly important with the emergence of lung cancer screening. Objectives: We report the results of the first utilization of a recently developed procedure in a bronchoscopy suite, which approaches solitary pulmonary nodules via a transparenchymal path. Methods: This study was a prospective, single-arm interventional study. We investigated patients with a solitary pulmonary nodule detected on CT imaging, which was suspicious for malignancy. The subject's CT was employed to calculate an airway wall point of entry (POE) as well as an avascular path through lung tissue from the POE to the solitary pulmonary nodule. Using a set of catheter-based tools under fused fluoroscopy guidance, a tunnelled tract was created from the POE to the nodule. The patients were surveyed for at least 72 h in our hospital. The primary end point of the study was to evaluate the feasibility to access and biopsy solitary pulmonary nodules outside of an operation theatre. Results: Six patients were recruited, and a tunnel pathway was created in 5 patients. There were no adverse events during the procedures. Two pneumothoraces were diagnosed by chest X-ray 2 h after the procedure, with one pneumothorax requiring drainage. Adequate biopsies were obtained from all 5 patients in whom a tunnel path was created. Conclusions: This study demonstrates that bronchoscopic transparenchymal access of solitary pulmonary nodules is feasible outside an operation theatre.
Herth FJF, Valipour A, Shah PL, et al., 2016, Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial, LANCET RESPIRATORY MEDICINE, Vol: 4, Pages: 185-193, ISSN: 2213-2600
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- Citations: 102
Torrego A, Shah PL, 2016, Transbronchial Lung Cryobiopsy: New Options for a New Reality, Respiration, Vol: 91, Pages: 204-205, ISSN: 1423-0356
Herth FJF, Slebos D-J, Rabe KF, et al., 2016, Endoscopic Lung Volume Reduction: An Expert Panel Recommendation, Respiration, Vol: 91, Pages: 241-250, ISSN: 1423-0356
Gogia P, Insaf TZ, McNulty W, et al., 2016, Endobronchial ultrasound: Morphological predictors of benign disease, ERJ Open Research, Vol: 2, ISSN: 2312-0541
The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study. Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied. The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72–0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present. Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.
Hopkinson NS, Polkey, Shah PL, et al., 2016, Effective Bronchoscopic Lung Volume Reduction Accelerates Exercise Oxygen Uptake Kinetics in Emphysema, Chest, Vol: 149, Pages: 435-446, ISSN: 1931-3543
The impact of bronchoscopic lung volume reduction (BLVR) on physiologic responses to exercise in patients with advanced emphysema remains incompletely understood. We hypothesized that effective BLVR (e-BLVR), defined as a reduction in residual volume > 350 mL, would improve cardiovascular responses to exercise and accelerate oxygen uptake (View the MathML sourceo2) kinetics.MethodsThirty-one patients (FEV1, 36% ± 9% predicted; residual volume, 219% ± 57% predicted) underwent a constant intensity exercise test at 70% peak work rate to the limit of tolerance before and after treatment bronchoscopy (n = 24) or sham bronchoscopy (n = 7). Physiologic responses in patients who had e-BLVR (n = 16) were compared with control subjects (ineffective BLVR or sham bronchoscopy; n = 15).Resultse-BLVR reduced residual volume (−1.1 ± 0.5 L, P = .001), improved lung diffusing capacity by 12% ± 13% (P = .001), and increased exercise tolerance by 181 ± 214 s (P = .004). View the MathML sourceo2 kinetics were accelerated in the e-BLVR group but remained unchanged in control subjects (Δ mean response time, −20% ± 29% vs 1% ± 25%, P = .04). Acceleration of View the MathML sourceo2 kinetics was associated with reductions in heart rate and oxygen pulse response half-times by 8% (84 ± 14 to 76 ± 15 s, P = .04) and 20% (49 ± 16 to 34 ± 16 s, P = .01), respectively. There were also increases in heart rate and oxygen pulse amplitudes during the cardiodynamic phase post e-BLVR. Faster View the MathML sourceo2 kinetics in the e-BLVR group were significantly correlated with reductions in residual volume (r = 0.66, P = .005) and improvements in inspiratory reserve volume (r = 0.56, P = .024) and exercise tolerance (r = 0.63, P = .008).ConclusionsLung deflation induced by e-BLVR accelerated exercise View the MathML sourceo2 kinetics in patients with emphysema. This beneficial effect appears to be
Sciurba FC, Criner G, Strange CB, et al., 2016, Efficacy Of Endobronchial Coil Implantation In Patients With Advanced Emphysema: Results Of The Renew Trial, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Strange CB, Herth FJF, Valipour A, et al., 2016, Step-Up Randomized Controlled Trial Of Segmental Vapor Ablation In Patients With Severe Emphysema: 6 Month Results, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Zoumot Z, Kemp SV, Shah PL, 2016, s Endobronchial Valves for Emphysema: Time to Push the Envelope?, RESPIRATION, Vol: 92, Pages: 359-361, ISSN: 0025-7931
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Valipour A, Shah PL, Gesierich W, et al., 2015, Patterns of Emphysema Heterogeneity, Respiration, Vol: 90, Pages: 402-411, ISSN: 1423-0356
Background: Although lobar patterns of emphysema heterogeneity are indicative of optimal target sites for lung volume reduction (LVR) strategies, the presence of segmental, or sublobar, heterogeneity is often underappreciated. Objective: The aim of this study was to understand lobar and segmental patterns of emphysema heterogeneity, which may more precisely indicate optimal target sites for LVR procedures. Methods: Patterns of emphysema heterogeneity were evaluated in a representative cohort of 150 severe (GOLD stage III/IV) chronic obstructive pulmonary disease (COPD) patients from the COPDGene study. High-resolution computerized tomography analysis software was used to measure tissue destruction throughout the lungs to compute heterogeneity (≥15% difference in tissue destruction) between (inter-) and within (intra-) lobes for each patient. Emphysema tissue destruction was characterized segmentally to define patterns of heterogeneity. Results: Segmental tissue destruction revealed interlobar heterogeneity in the left lung (57%) and right lung (52%). Intralobar heterogeneity was observed in at least one lobe of all patients. No patient presented true homogeneity at a segmental level. There was true homogeneity across both lungs in 3% of the cohort when defining heterogeneity as ≥30% difference in tissue destruction. Conclusion: Many LVR technologies for treatment of emphysema have focused on interlobar heterogeneity and target an entire lobe per procedure. Our observations suggest that a high proportion of patients with emphysema are affected by interlobar as well as intralobar heterogeneity. These findings prompt the need for a segmental approach to LVR in the majority of patients to treat only the most diseased segments and preserve healthier ones.
Koegelenberg CFN, Theron J, Dheda K, et al., 2015, Recommendations for the use of endoscopic lung volume reduction in South Africa: Role in the treatment of emphysema, South African Medical Journal, Vol: 105, Pages: 810-815, ISSN: 0256-9574
Emphysema is a very common cause of morbidity and mortality in South Africa (SA). Therapeutic options in severe emphysema are limited. Endoscopic lung volume reduction (ELVR) is increasingly being used internationally for the treatment of advanced emphysema in a subset of patients with advanced disease, aiming to obtain the same functional advantages as surgical lung volume reduction while reducing risks and costs. In addition to endobronchial valves, ELVR using endobronchial coils is now available in SA. The high cost of these interventions underscores the need for careful patient selection to best identify those who may or may not benefit from ELVR-related procedures. The Assembly on Interventional Pulmonology of the South African Thoracic Society appointed a committee comprising both local and international experts to extensively review all relevant evidence and provide advice on the use of ELVR in SA based on published evidence, expert opinion and local access to the various devices.
Herth FJF, Valipour A, Eberhardt R, et al., 2015, LATE-BREAKING ABSTRACT: Treating the most diseased segments in patients with severe emphysema: 6 month results from the STEP-UP randomized controlled trial (RCT), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Ernst A, Wahidi MM, Read CA, et al., 2015, Adult Bronchoscopy Training Current State and Suggestions for the Future: CHEST Expert Panel Report, CHEST, Vol: 148, Pages: 321-332, ISSN: 0012-3692
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- Citations: 66
Spiro SG, Hackshaw A, Shah P, et al., 2015, Research in progress-LungSEARCH: a randomised controlled trial of surveillance for the early detection of lung cancer in a high-risk group, Thorax, Vol: 71, Pages: 91-93, ISSN: 0040-6376
Low-dose CT screening for lung cancer is effective but expensive. Therefore, cheaper or more focused screening strategies may be required. LungSEARCH is a randomised prospective trial of 1568 high-risk individuals (ie, current or former moderate to heavy smokers with mild/moderate COPD) who undergo either annual sputum cytology/cytometry testing or no screening. Those with abnormal sputum then receive annual CT and fluorescent bronchoscopy for the remainder of 5 years, to identify early stage lung cancer. It is hoped that these simple initial tests could identify those requiring expensive CT scans, and the aim is to demonstrate a stage shift towards early stage cancers.
Zoumot Z, LoMauro A, Aliverti A, et al., 2015, Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony, Chest, Vol: 148, Pages: 185-195, ISSN: 1931-3543
BACKGROUND: Lung volume reduction (LVR) techniques improve lung function in selectedpatients with emphysema, but the impact of LVR procedures on the asynchronous movementof diff erent chest wall compartments, which is a feature of emphysema, is not known.METHODS: We used optoelectronic plethysmography to assess the eff ect of surgical and bronchoscopicLVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 monthsaft er LVR (surgical [n 5 9] or bronchoscopic [n 5 7]) or a sham/unsuccessful bronchoscopictreatment (control subjects, n 5 10). Chest wall volumes were divided into six compartments(left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen[Vab]) and phase shift angles ( u ) calculated for the asynchrony between Vrc,p and Vrc,a ( u RC),and between Vrc,a and Vab ( u DIA).RESULTS: Participants had an FEV 1 of 34.6 18% predicted and a residual volume of 217.846.0% predicted with significant chest wall asynchrony during quiet breathing at baseline( u RC, 31.3° 38.4°; and u DIA, 2 38.7° 36.3°). Between-group diff erence in the change in u RCand u DIA during quiet breathing following treatment was 44.3° (95% CI, 2 78 to 2 10.6;P 5 .003) and 34.5° (95% CI, 1.4 to 67.5; P 5 .007) toward 0° (representing perfect synchrony),respectively, favoring the LVR group. Changes in u RC and u DIA were statistically signifi canton the treated but not the untreated sides.CONCLUSIONS: Successful LVR signifi cantly reduces chest wall asynchrony in patients withemphysema. CHES
Davey C, Zoumot Z, Jordan S, et al., 2015, Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial, Lancet, Vol: 386, Pages: 1066-1073, ISSN: 1474-547X
BackgroundLung volume reduction surgery improves survival in selected patients with emphysema, and has generated interest in bronchoscopic approaches that might achieve the same effect with less morbidity and mortality. Previous trials with endobronchial valves have yielded modest group benefits because when collateral ventilation is present it prevents lobar atelectasis.MethodsWe did a single-centre, double-blind sham-controlled trial in patients with both heterogeneous emphysema and a target lobe with intact interlobar fissures on CT of the thorax. We enrolled stable outpatients with chronic obstructive pulmonary disease who had a forced expiratory volume in 1 s (FEV1) of less than 50% predicted, significant hyperinflation (total lung capacity >100% and residual volume >150%), a restricted exercise capacity (6 min walking distance <450 m), and substantial breathlessness (MRC dyspnoea score ≥3). Participants were randomised (1:1) by computer-generated sequence to receive either valves placed to achieve unilateral lobar occlusion (bronchoscopic lung volume reduction) or a bronchoscopy with sham valve placement (control). Patients and researchers were masked to treatment allocation. The study was powered to detect a 15% improvement in the primary endpoint, the FEV1 3 months after the procedure. Analysis was on an intention-to-treat basis. The trial is registered at controlled-trials.com, ISRCTN04761234.Findings50 patients (62% male, FEV1 [% predicted] mean 31·7% [SD 10·2]) were enrolled to receive valves (n=25) or sham valve placement (control, n=25) between March 1, 2012, and Sept 30, 2013. In the bronchoscopic lung volume reduction group, FEV1 increased by a median 8·77% (IQR 2·27–35·85) versus 2·88% (0–8·51) in the control group (Mann-Whitney p=0·0326). There were two deaths in the bronchoscopic lung volume reduction group and one control patient was unable to attend for follow-up asse
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