Evidence grows for efficacy of endobronchial coils

Evidence is growing to support the use of endobronchial coils in patients with severe emphysema, with the release of one of the most significant studies to date.

However questions still remain over whether the treatment is best suited to patients with homogeneous or heterogeneous emphysema, or both.

Brisbane-based thoracic physician Dr David Fielding – one of the few Australian specialists who have implanted endobronchial coils in patients– said he believed the coils definitely had some role to play in the treatment of people with severe emphysema.

“It’s still very early days, we are probably at a similar point to where we were at with valves 5-6 years ago,” he told the limbic. “We’re now at a point where we’ve got rock solid indications for (endobronchial) valves; I just don’t think we’re there yet with coils.”

The results of the REVOLENS Randomized Clinical Trial were published in this month’s JAMA . The trial looked at 100 cases across 10 sites in France, 50 of which were patients who had coils implanted.

Dr Fielding said this was a ‘very significant’ contribution to existing literature on the coils.

“There have only been 120-140 cases ever written up so it’s very powerful from that perspective,” he said.

Of the patients in the coil group, 36 per cent achieved improvement of at least 54m in the six-minute walk test at six months, compared to 18% in the usual care group.

Dr Fielding said this was significant because it translated into improved quality of life and ability to persist with daily activities.

He has seen positive results in the two patients he had implanted coils in last year at the Royal Brisbane and Women’s Hospital. He said both male patients were leading active lives, one playing regular golf and the other training in a gym with a personal trainer.

“They’re both very happy with the results,” he said.

Dr Fielding said he suspected that coil treatment might be better suited to patients with heterogeneous emphysema, however this was just a ‘hunch’ that was yet to be scientifically validated.

Endobronchial coil treatment is a minimally invasive procedure during which about 10 implants made of nickel titanium are placed into the diseased areas of each lung.

Once in place, the coils gently regain their shape, gathering up loose lung tissue and holding open surrounding airways in the process.

Editors note: The coils are branded “RePneu” endobronchial coils and are distributed by in Australia by N. Stenning & Co. After going to press a spokesperson for the company told the limbic the coils were commercially available in Australia and they were in the process of seeking reimbursement through a prostheses rebate.

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