INTRODUCTION:Endoscopic lung volume reduction with coils is a symptomatic treatment approach for patients with severe pulmonary emphysema and positive collateral ventilation. In this study, we evaluated the safety and feasibility of the new Lung Volume Reduction Reverser (LVR-R) system. METHODS:Prospective, nonrandomized, exploratory, single-center, first-in-man study in 15 patients with chronic obstructive pulmonary disease (COPD) and severe emphysema. Most affected lung lobes were treated sequentially with the LVR-R coils from May 2019 to JUL 2022. Pulmonary function, 6-min walking distance (6-MWD), questionnaires and adverse events were recorded from baseline to 1-year post-procedure. Computer tomography was acquired at baseline and 6 months. RESULTS:A total of 28 procedures were performed, in which 10 (n = 22, 78.6%), 9 (n = 2, 7.1%), or 8 (n = 4, 14.3%) LVR-R coils were implanted, predominantly in the upper lobes (n = 26/28, 92.86%). Two patients refused a second treatment, one of whom refused follow-ups. Adverse events at 3 months included severe pneumonia and/or COPD exacerbations (n = 7), ventilatory failure (n = 2) and 1 pneumothorax requiring thoracic drainage. Mild hemoptysis occurred in 18 and mild pneumonia and/or COPD exacerbations in 9 patients. Overall, neither FEV1, residual volume, 6-MWD, CAT nor mMRC improved within 1-year (n.s. all). In 2 patients, response in FEV1 >500 mL occurred. CONCLUSION:In this severely diseased and small patient cohort, LVR-R implantation was technically feasible. The complication rate was similar to other coil studies and requires a careful pre-procedure benefit-risk evaluation. Two of fourteen bilaterally treated individuals demonstrated a notable improvement in lung function.

BACKGROUND:Endoscopic lung volume reduction (ELVR) is increasingly used for treating patients with chronic obstructive pulmonary disease (COPD) and severe hyperinflation. Data on sex differences in ELVR outcomes are lacking, highlighting the need for detailed analysis. METHODS:This retrospective analysis examines sex-specific outcomes of ELVR with bronchoscopic valve placement using data from the German Lung Emphysema Registry (January 2017 to January 2025). RESULTS:The final analysis included 778 patients, 378 (47.2%) women, mean age 65.9±7.6 years. No significant differences in age or body mass index. At baseline, women had slightly better forced expiratory volume in 1 s (FEV1)% (31.4±8.5 vs 28.1±8.1, p<0.001) and vital capacity% (63.6±16.9 vs 59.2±14.8, p<0.001), but similar residual volume (RV)%. Men had higher rates of cardiovascular diseases, including coronary artery disease (20.9% vs 11.7%) and atrial fibrillation (7.3% vs 3.5%), p<0.05. Despite this, women reported a higher symptom burden with higher COPD Assessment Test (CAT) scores (25.9±6.1 vs 24.9±6.1, p<0.001), but similar St. George's Respiratory Questionnaire (SGRQ) scores. Follow-up at 3 months for 574 patients showed no sex differences in ΔFEV1%, ΔRV% or Δdiffusing capacity of the lung for carbon monoxide%. Differences in treatment response were noted for ΔCAT score (-4.3±6.8 vs -1.9±6.1, p<0.001), ΔSGRQ (-13.2±17.3 vs -5.5±12.48, p<0.001), but not for dyspnoea. Multivariable analyses showed female sex (OR 1.89) as an independent predictor for SGRQ response, along with emphysema heterogeneity (OR 1.01) and pulmonary function response (ΔRV, OR 0.73). CONCLUSIONS:Sex may not influence physiological outcomes but may impact symptom severity and quality of life, raising the question of whether sex should be considered when determining minimal clinically important differences in COPD.

INTRODUCTION:Endoscopic lung volume reduction (ELVR) via valves is a proven therapeutic option for patients with advanced chronic obstructive pulmonary disease (COPD) and emphysema without collateral ventilation. Body mass index (BMI), a simple measure of adiposity, has a complex relationship with COPD. A lower BMI is associated with increased mortality in this patient population. However, the influence of BMI on the outcome of ELVR remains unclear. METHODS:This analysis was conducted with data from the Lung Emphysema Registry (www.lungenemphysemregister.de), a national, prospective, multicentric, producer-independent, open-label clinical trial. The aim of this study was to evaluate the impact of baseline BMI on treatment outcomes after ELVR. Patients were grouped according to their BMI as follows: underweight (BMI <20 kg/m2, n = 76), normal weight (20-24.9 kg/m2, n = 282), overweight (BMI = 25-30 kg/m2, n = 146), and obese (BMI >30 kg/m2, n = 45). RESULTS:Baseline parameters were characteristic of patients with advanced lung emphysema. Emphysema scores and heterogeneity indices of the target lobe were greater in patients with lower BMI. Patients with a lower BMI had worse lung function parameters (FEV1, RV, DLCO, pCO2) and a higher CAT score. All groups showed significant improvements after ELVR at the 3-month follow-up in terms of lung function parameters, exercise capacity, and quality of life. Treatment outcomes were comparable across BMI groups, with the notable exception of more pronounced improvement in CAT scores among underweight patients. The complication rates were low and comparable among the groups, although obese patients had a higher rate of ICU admissions. CONCLUSION:This study suggests that ELVR provides meaningful clinical benefits regardless of BMI in patients with advanced lung emphysema, particularly when dyspnea is primarily attributable to pulmonary pathology. The findings suggest that BMI should be considered as a reflection of disease phenotype and clinical state rather than serving as a predictor for treatment response after ELVR.

Endoscopic lung volume reduction (ELVR) using endobronchial valves is an established treatment for advanced COPD and emphysema. To reduce procedure-related complications such as pneumonia or exacerbations, peri-interventional antibiotic prophylaxis is commonly used; however, its clinical benefit remains uncertain. We aimed to evaluate the effect of different peri-interventional antibiotic strategies in a German COPD cohort. Comparative analyses were performed using data from 900 patients enrolled in the multicentre, observational German Lung Emphysema Registry (LE-Registry). Patients were categorized by peri-interventional antibiotic strategy: single-dose prophylaxis, prolonged prophylaxis for 5–7 days, or no prophylaxis. Baseline characteristics, airway colonization, lung function, symptom burden, exercise capacity, and adverse events were assessed up to three months after ELVR. Among 900 patients undergoing ELVR, 104 received single-dose prophylaxis, 344 prolonged 5–7-day prophylaxis, and 309 no antibiotic prophylaxis. Clinical improvements in lung function, symptom burden, and exercise capacity over three months were similar across all groups. Exacerbations occurred in 11.5

INTRODUCTION:Sedation during flexible bronchoscopy can be administered by a second physician, an anesthesiologist or as nurse-administered sedation (NAS). Propofol is often administered by non-anesthesiologists. It is unclear whether complications differ with various sedation protocols. METHODS:We searched PubMed for clinical trials of sedation during bronchoscopy and conducted a systematic review of complications (death ≤24 h post-procedure or intensive care unit (ICU) admission/predefined cardiopulmonary escalation [CPE]). Outcomes were analyzed according to the staff administering sedation, complexity of procedure, for propofol-containing regimes, and the ASA physical status classification of the patient. RESULTS:This analysis (120 articles, 39,475 procedures) showed a mortality rate of 0.01% for sedation bronchoscopy. ICU admission rate was 0.12%, and CPE was reported in 0.57%. Significantly higher CPE was recorded for anesthesiologists compared to NAS and second physicians (1.16% vs. 0.65% vs. 0.07%, respectively, p < 0.001) with higher ICU admission for NAS compared to anesthesiologists and second physicians (0.35% vs. 0.00% vs. 0.03%, respectively, p < 0.001). Endobronchial ultrasound did not increase complication rates. Admission to ICU and CPE remained <1% in propofol-containing regimes, although complications were slightly lower without propofol. Comparison of lower risk ASA 1-2 studies compared to studies with ASA 1-3 showed no significant difference in outcome. CONCLUSION:Sedation bronchoscopy is a safe procedure. The staff administering sedation may react differently to periprocedural respiratory and cardiovascular events. Propofol application is not associated with a clinically relevant increase in complication rate. There is no evidence that ASA status is a predictor of individual risk at bronchoscopy.

Chest quantitative computed tomography (QCT) has been used in clinical trials to monitor patients with alpha-1 antitrypsin deficiency (AATD). There is limited data on the use of quantitative computed tomography (QCT) to phenotype emphysema in AATD. Data from patients with a reduced AATD serum level and/or at least one deficiency mutation, who underwent a chest CT scan at the Thoraxklinik, University of Heidelberg, between 03/2012 and 02/2024, were retrospectively analyzed. The patients were categorized into three groups based on their AAT serum levels: reduced to normal (> 70 mg/dl), moderate (41–70 mg/dl), and severe (≤ 40 mg/dl). The QCT analyses were performed using a fully automated quantitative CT software package (YACTA v2.9.4.98). In this retrospective cohort study, 75 AATD patients were analysed, including 13 with reduced-to-normal AATD, 16 with moderate AATD and 46 with severe AATD. The mean age was 54.3 ± 14.7 years with no differences between groups. Significant differences in pack-years (PY) were found: reduced to normal 14.9 ± 17.2, moderate 39.4 ± 31.9 and severe 15.1 ± 14.6 (p < 0.001). There were no differences in predicted FEV1

BACKGROUND:The ninth edition of the TNM classification (TNM-9) for NSCLC introduces distinct N2 subgroups based on single (N2a) or multiple (N2b) involved stations, impacting prognosis and staging. This survey aimed to assess the impact of these changes on mediastinal staging with EBUS-TBNA, particularly regarding the need for needle change when sampling lymph nodes from different N2 stations. METHODS:A 10-question online questionnaire was distributed from March 4, 2025 to March 16, 2025, to pulmonologists through interventional pulmonology sections of medical societies, online networks, and social media. RESULTS:A total of 605 questionnaires from 66 countries were analyzed. Most respondents were males (58.8%), aged 40 to 49 years, and worked in academic hospitals. Regarding EBUS procedure frequency, 28.9% performed 1 to 2 procedures weekly, and 13.6% performed more than 10. When asked about the need for needle change between different N2 stations, 20.7% saw it as necessary, 33.2% disagreed, and 17.4% considered it necessary in some cases. Although 38.1% considered changing the needle at least sometimes, only 5.5% reported actually doing so. The main barriers were costs (68.3%) and lack of evidence (31.3%). Those against needle change cited the belief that it does not affect results (58.2%), lack of evidence (54.2%), and other factors (4.5%), with many considering flushing the needle sufficient. Free-text responses indicated a lack of knowledge or implementation of TNM-9 in some centers. CONCLUSION:Opinions on implementing TNM-9 are inconsistent, within the IP community, particularly regarding needle change for different N2 stations. Education, reliable data, and consensus guidelines are needed.

We read with interest the study by Akil et al [...]

There are well-documented differences in idiopathic pulmonary fibrosis (IPF) between sexes. The sex-specific prevalence of interstitial lung disease (ILD) subtypes in patients who require a full diagnostic work-up, including transbronchial cryobiopsy (TCB), after initial multidisciplinary discussion (MDD) is still unknown. Retrospective analysis of sex dispareties in patients with ILD who received an interdisciplinary indication for lung biopsy and underwent bronchoalveolar lavage, TCB and, if necessary, surgical lung biopsy at our ILD centre in Heidelberg between 11/17 and 12/21. The analysis included clinical parameters, visual assessment of computed tomography (CT), automated histogram analyses of lung density by validated software and final MDD-ILD classifications. A total of 402 patients (248 men, 154 women; mean age 68 ± 12 years) were analysed. Smoking behaviour was similar between the sexes, but women were more exposed to environmental factors, whereas men were more exposed to occupational factors. Women had higher rates of thyroid disease (29.9% vs. 12.5%; p < 0.001) and extrathoracic malignancies (16.2% vs. 9.3%; p = 0.041), but lower rates of coronary heart disease (7.1% vs. 19.8%; p < 0.001), stroke (1.3% vs. 6.5%; p = 0.014) and sleep apnoea (5.8% vs. 17.7%; p < 0.001). There were no sex differences regarding CT lung density. On visual inspection, women were less likely to have reticular opacities (65% vs. 76%; p = 0.017) and features of usual interstitial pneumonia (17% vs. 34%; p < 0.001). Among final diagnoses, hypersensitivity pneumonitis was more common in women (34.4%) compared to men (21.8%; p = 0.007). In contrast, IPF was more common in men (22.6%) than in women (7.1%; p < 0.001), and unclassifiable interstitial lung disease was also more frequent in men (21.8%) compared to women (6.5%; p < 0.001). This study highlights significant sex-based differences in the prevalence and characteristics of ILD requiring comprehensive diagnostic work-up. These findings underscore the importance of considering sex-specific factors in the diagnosis and management of ILD.

In COPD patients with severe right-sided emphysema, complete major and incomplete minor fissure, implantation of one-way valves in both the right upper (RUL) and middle lobes (ML) is a possible approach for endoscopic lung volume reduction. The aim of this retrospective analysis was to evaluate the response to therapy and the complication rate at 90 days (90d-FU) after combined RUL-ML valve implantation. This retrospective, monocentric study included all patients from the Thoraxklinik Heidelberg who underwent RUL-ML valve treatment between 2012 and 2023 with available follow-up data. Quantitative chest imaging, lung function, 6-minute walking distance (6-MWD), complications and indications for re-bronchoscopies until 90d-FU were analysed. 28 patients underwent combined RUL-ML valve treatment, predominantly sequentially (92.86

Cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are muco-obstructive lung diseases. Knowledge of molecular processes has much improved therapeutic options in CF, whereas much less is known for COPD, a disease affecting an increasing number of patients. Here, we report a multilayer workflow integrating microbiome, inflammation and proteome profiling with clinical data to identify disease specific characteristics in sputum. Our proof-of-concept study shows that CF sputum is dominated by Pseudomonas and Staphylococcus, exhibits heightened neutrophilic inflammation, and a severe protease-antiprotease imbalance. In contrast, COPD displays heterogeneous microbiome composition, eosinophilic inflammation, and altered extracellular matrix remodeling. Proteome-based cellular deconvolution identifies disease-specific immune cell signatures, underscoring the complexity, especially in COPD. Multi-omics factor analysis suggests that matrisome and nucleotide metabolism changes may act as disease discriminators, though future confirmation in larger cohorts is needed. These findings highlight the potential of our integrated approach to uncover sputum biomarkers as tools for patient stratification and personalized therapeutic strategies in CF and COPD.

OBJECTIVES:This study aimed to investigate the association of explicitly severe chronic obstructive pulmonary disease (COPD) with oral conditions considering in-depth shared risk factors. METHODS:A case-control study was conducted with 104 participants, 52 with severe COPD and 52 matched controls without COPD. Dental and periodontal status were clinically assessed and oral health-related quality of life (OHRQoL) by OHIP-G14-questionnaire. RESULTS:Between COPD- and control-group, there were no statistically significant differences regarding age (66.02 ± 7.30), sex (female: 52 [50%]), smoking history (44.69 ± 23.23 pack years) and number of systemic diseases (2.60 ± 1.38). COPD patients demonstrated significantly fewer remaining teeth (12.58 ± 9.67 vs. 18.85 ± 6.24, p < 0.001) besides higher DMFT (decayed, missing and filled teeth) index (21.12 ± 5.83 vs. 19.10 ± 3.91, p = 0.036). They had significantly greater probing pocket depths (PPD: 3.24 mm ± 0.71 mm vs. 2.7 mm ± 0.37 mm, p < 0.001) and bleeding on probing (BOP: 34.52% ± 22.03% vs. 22.85% ± 17.94%, p = 0.003) compared to controls, but showed no significant difference in clinical attachment level or staging of periodontitis. The OHIP-G14 sum score was significantly higher in COPD patients (7.40 ± 7.28 vs. 3.63 ± 4.85, p = 0.002). Common risk factors such as educational status, physical activity, dentist visit frequency, oral hygiene regimens and dietary habits were less favourable in patients with COPD. CONCLUSIONS:COPD was significantly associated with higher tooth loss, PPD, BOP and DMFT besides lower OHRQoL.

ZusammenfassungBronchoskopiekurse sollten einen festen Bestandteil der bronchoskopischen Ausbildung darstellen. Kursabsolventen sollen nach dem Bronchoskopiekurs mit den Indikationsfeldern, Voraussetzungen und technischen Möglichkeiten der Bronchoskopie vertraut sein. Neben theoretischen Inhalten werden in Kleingruppen am Bronchoskopiemodell unter Supervision praktische bronchoskopische Fertigkeiten vermittelt und am Simulationsmodell trainiert. Die Grundlage der vermittelten Inhalte sind dabei die aktuellen Leitlinien und Empfehlungen der DGP sowie die geltenden Richtlinien und KRINKO-Empfehlungen. Die Vereinheitlichung zentraler Kurselemente dient der flächendeckenden Qualitätssicherung, dennoch sollen lokale standortspezifische Schwerpunktsetzungen explizit unterstützt werden.