Bronchoscopic Nitinol Coil Implantation: A New Lung Volume Reduction Strategy in COPD

Emphysema is a progressive, debilitating disease characterised by irreversible destruction of lung tissue. The gas trapping within the destroyed alveoli, and resultant hyperinflation, render conventional medical treatment generally of limited benefit, especially in the advanced stages of the disease. Utilisation of bronchoscopic techniques for achieving lung volume reduction has advanced over the past years. Amongst these, lung volume reduction using coils (LVRC) is a promising option. The LVRC are made from preformed Nitinol wire with shape memory. They are bronchoscopically delivered into the desired sub-segmental bronchus and recover to a pre-determined shape upon deployment. Published data so far, with endpoints being safety and feasibility, are promising. The procedure itself seems to be technically feasible and results in significant improvements in pulmonary function, exercise capacity, and quality of life sustained during the follow-up period, and with an overall acceptable safety profile. Current ongoing studies further investigate the feasibility, safety, and efficiency of LVRC. Future research is necessary in order to elucidate whether the patient selection criteria and methodology currently used are amenable to improvements, and to establish the duration of benefit and its cost-effectiveness when compared to optimal medical treatment, before applying this treatment into routine clinical practice.