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Endobronchial Valves COPD — RACP Adult Medicine MCQ

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ModerateRespiratoryEndobronchial Valves COPDRACP Adult Medicine

A 55-year-old man with severe COPD (FEV₁ 30%) has completed pulmonary rehabilitation. He remains symptomatic (mMRC 3) on triple inhaler therapy (ICS/LAMA/LABA). He has heterogeneous emphysema with intact interlobar fissures on CT. He is not a surgical candidate. What minimally invasive intervention may be offered?

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Correct answer: C — Endobronchial valve therapy (BLVR)

Endobronchial valve therapy (e.g., Zephyr valves — LIBERATE trial, STELVIO trial) is a minimally invasive alternative to LVRS for heterogeneous emphysema with intact fissures (no collateral ventilation). Valves are placed bronchoscopically in the target lobe → lobar atelectasis → lung volume reduction. Inclusion criteria: FEV₁ 15-45%, RV >175%, heterogeneous emphysema, intact fissures on CT (or confirmed by Chartis catheter). Main complication: pneumothorax (~25%). Improvement in FEV₁ (~20-30%) and quality of life.

Reference: COPD-X 2024; LIBERATE Trial; TSANZ 2024