Rationale for Endobronchial Coil Treatment as the Primary Intervention for Patients with Severe Emphysema

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive, and debilitating disease, particularly in its final stages. The National Emphysema Treatment Trial demonstrated that surgical removal of diseased portions of the emphysematous lung improved clinical and functional status of a subgroup of severe patients with upper-lobe predominant emphysema and low baseline exercise tolerance. However, questions about morbidity, mortality, and costs have all fuelled growing enthusiasm for endoscopic methods of achieving improved clinical outcomes in this poorly-served patient population. Among the various available methods, endobronchial coil therapy is a particularly promising technique that improves exercise capacity, pulmonary function, and quality of life in severe emphysema, with an acceptable safety profile and growing clinical evidence of sustained improvement. Notably, coil treatment appears effective in broader groups of patients than can be treated with other methods or surgery. Coil treatment as the preferred method for treating severe emphysema represents a welcome paradigm shift, given the known limitations of endobronchial valves and surgery. This review addresses the clinical data available to date and proposes an alternate framework for selecting and treating patients with endobronchial coils.