Lung volume reduction surgery (LVRS) was not significantly superior to bronchoscopic lung volume reduction (BLVR) with valve placement in patients with emphysema who were eligible for both treatment options. These important findings to guide treatment decisions are currently being evaluated in a larger trial.
Although LVRS and endobronchial valves (EBVs) have both demonstrated to improve lung function, exercises capacity, and quality-of-life for patients with emphysema, no existing clinical trials have directly compared LVRS with the use of EBVs [1,2]. The randomised, single-blind CELEB trial (ISRCTN19684749) assessed whether LVRS was superior to BLVR in patients with emphysema who were suitable for both procedures (n=88) . The primary endpoint was the Body-mass index, airflow Obstruction, Dyspnea, and Exercise index (i-BODE) score at 12 months, a measure that includes forced expiratory volume in 1 second (FEV1) % predicted, exercise capacity, dyspnoea, and BMI. Ms Sara Buttery (Royal Brompton and Harefield NHS Foundation Trust, UK) presented the results.
The improvements on the i-BODE score at 12 months were comparable for LVRS and BLVR (-1.10 vs -0.82; P=0.54; see Figure). Analysis of the single components of the i-BODE score did not reveal a significant advantage of 1 treatment over the other. Moreover, the residual volume % (RV%) predicted was similar in the LVRS arm and BLVR arm (-36.1% vs -30.1%; P=0.81). Finally, the safety of the procedures appeared to be similar, with 1 death at 12 months in each arm of the study.
Figure: Primary outcome of the CELEB trial 
i-BODE, Body-mass index, airflow Obstruction, Dyspnea, and Exercise index; LVRS, lung volume reduction surgery; BLVR, bronchoscopic lung volume reduction.
Ms Buttery concluded that LVRS was not substantially superior to BLVR in the current trial. A larger trial (NCT04537182) is underway to confirm these findings and to evaluate the cost-benefit of the 2 treatments.
- Criner G, et al. Am J Respir Crit Care Med. 2011;184(7).
- Kemp SV, et al. Am J Respir Crit Care Med. 2017;196(12).
- Buttery S, et al. Comparative Effect of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: the CELEB trial. ALERT 4, RCT4448, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
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Table of Contents: ERS 2022
Letter from the Editor
ERS 2022 Highlights Podcast
COVID-19: What Is New?
Does vilobelimab reduce mortality in severe COVID-19?
Awake proning not positive in COVID-19
Favipiravir may help patients over 60 years with COVID-19 to recover
Brensocatib fails in severe COVID-19
Inhaled agent under investigation for COVID-19
Accurate voice-based COVID-19 diagnostic test in development
Novel scoring tool for post-COVID syndrome aids clinicians and researchers
COPD: Therapies and Innovations
Icenticaftor achieves results on top of triple inhalation therapy in COPD
STARR2: A new approach for treating COPD exacerbations
COPD medication not effective in symptomatic smokers with preserved spirometry
Do digital tools improve physical activity in COPD?
Hyperpolarised gas MRI ready for clinical use
All About Asthma
Tezepelumab in asthma: mucus plugging down, lung function up
Digital asthma intervention improves health and reduces costs
Digitally enhanced therapy lowers treatment burden and costs in severe asthma
Mepolizumab beneficial for patients with severe eosinophilic asthma
Progress in Paediatrics
Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis
Inhaled corticosteroids useful in preterms with decreased lung function
Fish oil or vitamin D during pregnancy can prevent croup
Encouraging results of nintedanib in children with fibrosing ILD
Focus on Interventional Pulmonology
Head-to-head: lung volume reduction surgery vs endobronchial valves
Durable effect of endobronchial valves in severe emphysema
Cone beam CT-guided ENB improves detection of pulmonary nodules
Confirmatory mediastinoscopy not needed in resectable NSCLC
Sleep and Breathing Disorders
In the spotlight: Cancer trends in obstructive sleep apnoea
Impact of CPAP on cardiac endpoints in OSA
Sustained hypoxaemia predicts unprovoked VTE in OSA
CPAP therapy in the prevention of cardiovascular risk in patients with OSA
Other Remarkable Research
Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure
Antifibrotic therapy may slow down FVC decline in RAILD
Intravenous N-acetylcysteine performs well in hospitalised patients
Men and women respond differently to diesel exhaust
New trends in cystic lung diseases
Nintedanib and sildenafil
COVI-PRONE trial on its back