Endobronchial Valves for Bronchoscopic Lung Volume Reduction in Severe Emphysema: A Reversible and Non-Surgical Treatment for Patients Who May or May Not Be Candidates for Lung Transplantation

Chronic obstructive pulmonary disease remains a leading cause of death worldwide, with emphysema contributing significantly to dyspnea, exercise limitation, and mortality. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs) has emerged as a minimally invasive, reversible alternative to lung volume reduction surgery for carefully selected patients with severe emphysema who remain symptomatic despite optimal medical therapy. EBVs are one-way valves placed bronchoscopically to achieve complete lobar occlusion, inducing atelectasis of the most diseased lung segments while allowing better ventilated parenchyma to expand, thereby improving respiratory mechanics and reducing hyperinflation. Landmark randomized controlled trials demonstrated that BLVR using EBVs produces significant improvements in forced expiratory volume in one second (FEV1), exercise capacity, and quality of life comparable to surgical lung volume reduction but with reduced morbidity and mortality. Critical to treatment success is meticulous patient selection based on emphysema distribution, absence of collateral ventilation, and appropriate physiologic parameters. Pneumothorax represents the most common serious complication, occurring in approximately 26% of patients, though paradoxically, it indicates successful lobar occlusion and predicts favorable long-term outcomes. As the most extensively studied BLVR, endobronchial valve therapy represents a cornerstone intervention for appropriately selected patients with severe emphysema.