Poor man medical pneumoplasty: Bronchoscopic lung volume reduction with hot saline versus dissolved doxycycline as a neoteric remedy of pulmonary emphysema

Abstract

Background: Endoscopic lung volume reduction maneuver using simple inexpensive reagents to remodel and shrivel damaged regions of the lung has been accomplished in managing human with pulmonary emphysema as a surrogate for surgical interference. Objectives: Evaluation of the safety and efficacy of hot saline versus dissolved doxycycline (vibramycin) for lung volume reduction of emphysematous lung in both adult and pediatric age groups. Patients and methods: Prospective clinical study was conducted on 21 patients with pulmonary emphysema. They were submitted to fiberoptic bronchoscopy (FOB), chest computed tomography (CT) and comprehensive respirometry. They were divided into two groups: group I underwent FOB instillation of hot saline with 50 °C in two consecutive sessions and group II underwent FOB instillation with dissolved doxycycline in normal saline also in two consecutive sessions, and each procedure then repeated after one week. Results: The total success rate of the procedure in group I was 72.72% and in group II 70% however the total success rate in the studied cases was 71.43%. The procedure success in adult age group in group I represented 77.7% on the other hand in group II it reached 75% and the total therapeutic success rate was 76.74% while in the pediatric age group it accomplished an equal percentage (50%) in both groups. Conclusion: Bronchoscopic lung volume reduction by hot saline and dissolved doxycycline comes into sight to be a safe and feasible profile with an acceptable outcome that presents an attractive substitute to COPD patients who are physiologically friable.

Keywords

• Lung volume reduction
• Hyperinflation
• Doxycycline
• CT chest
• Hot saline