Keywords:
COPD, Emphysema, Lung volume reduction

In patients with severe emphysema, surgical or novel bronchoscopic lung volume reduction therapies are potential additional treatment options that can result in significant improvements in pulmonary function, exercise capacity and quality of life [1,2,3,4]. At our Department of Pulmonary Diseases, we receive hundreds of referrals for these interventions every year. We have been able to observe Nature at work in several of these patients; 3 of our patients have reported a significant spontaneous improvement in exercise performance and quality of life over the past years without having to have any medical intervention. After a careful review of their medical charts, pulmonary function tests and available radiological imaging, it appeared that all 3 showed a significant improvement in pulmonary function, which occurred after visible changes on their chest X-ray or chest CT scans. These reported measurements were all taken with the patients in a stable state.

In all 3 patients, chest imaging showed a significant volume reduction of the previously most diseased parts of their lungs (fig. 1). In the first patient, a 44-year-old male, this was preceded by a large, infected bulla occupying about half of the right thoracic volume, and concurrent pneumonia. Before the event, he had had an FEV1 of 0.81 liters (20% of predicted) and a residual volume (RV) of 7.49 liters (378% of predicted), both of which improved [to FEV1 1.75 liters (44% of predicted) and RV 4.85 liters (233% of predicted)]. In the other 2 patients, no specific clinical event preceding the spontaneous improvement was reported. In the second patient, a 56-year-old male, FEV1 was 0.72 liters (18% of predicted) and RV 7.71 liters (320%), improving to 1.17 liters (30% of predicted) and 5.48 liters (227% of predicted), respectively. In the third patient, a 65-year-old male, FEV1 was 0.84 liters (24% of predicted) and RV was 6.39 liters (261% of predicted), changing to 1.03 liters (29%) and 4.79 liters (190% of predicted), respectively.

Fig. 1
Fig. 1. Chest X-rays of patient number 1 (a 44-year-old male). a Bilateral severe emphysema. b Autobullectomy of the right upper lobe, which resulted in a remarkable spontaneous clinical improvement.
View largeDownload slide

Chest X-rays of patient number 1 (a 44-year-old male). a Bilateral severe emphysema. b Autobullectomy of the right upper lobe, which resulted in a remarkable spontaneous clinical improvement.

Fig. 1
Fig. 1. Chest X-rays of patient number 1 (a 44-year-old male). a Bilateral severe emphysema. b Autobullectomy of the right upper lobe, which resulted in a remarkable spontaneous clinical improvement.
View largeDownload slide

Chest X-rays of patient number 1 (a 44-year-old male). a Bilateral severe emphysema. b Autobullectomy of the right upper lobe, which resulted in a remarkable spontaneous clinical improvement.

Close modal

Although almost every pulmonary physician might be able to memorize a similar remarkable case of ‘natural improvement' from their own practice, surprisingly, after a thorough search of the literature, there are only a few reports of patients having had a spontaneous lung volume reduction or so-called ‘autobullectomy' [5]. This natural course is an exciting finding, and its significant benefit for our patients also demonstrates the potential impact of lung volume reduction therapies in this patient group. Recognizing autobullectomy furthermore helps the understanding of sudden changes in the natural course of COPD.

1.
Fishman A, Martinez F, Naunheim K, et al: A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003;348:2059-2073.
2.
Herth FJ, Eberhardt R, Gompelmann D, et al: Radiological and clinical outcomes of using ChartisTM to plan endobronchial valve treatment. Eur Respir J 2013;41:302-308.
3.
Slebos DJ, Klooster K, Ernst A, et al: Bronchoscopic lung volume reduction coil treatment of patients with severe heterogeneous emphysema. Chest 2012;142:574-582.
4.
Gasparini S, Zuccatosta L, Bonifazi M, et al: Bronchoscopic treatment of emphysema: state of the art. Respiration 2012;84:250-263.
5.
Goodman RB, Lakshminarayan S: Images in clinical medicine. Inflammatory autobullectomy. N Engl J Med 1996;23:1372-1373.
© 2012 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.