重症慢性閉塞性肺疾患に対する気管支鏡的肺容量減量術

Bronchoscopic Lung Volume Reduction for Severe Chronic Obstructive Lung Disease

NICE studyの結果，日本における慢性閉塞性肺疾患（COPD）患者数は210万人以上，年間死亡者数は13,000人を超えると推定されている．厚生労働省は「健康日本21（第3次）」において，新たにCOPDの重症化予防をテーマとして加え，日本呼吸器学会ではCOPD死亡率の低減をめざす「木洩れ陽COMORE-By2032」プロジェクトを始動した．

Bronchoscopic lung volume reduction （BLVR） has a history of over 10 years and has been performed in more than 25,000 cases worldwide. It is recommended with an evidence A rating in the Global Initiative for Chronic Obstructive Lung Disease （GOLD） guidelines. However, in Japan, it was only approved for insurance coverage in December 2023, and treatment has just begun at designated facilities. BLVR serves as a treatment option that bridges the gap between medical and surgical treatments for severe chronic obstructive pulmonary disease （COPD） cases. In Japan, where homogeneous emphysema is more prevalent, BLVR offers a promising new treatment option for severe COPD patients who continue to experience dyspnea despite receiving maximal medical therapy. The success of BLVR depends on proper patient selection based on appropriate evaluation, including the assessment of collateral ventilation using the Chartis system. Patients undergoing BLVR can expect improvements in FEV1.0 and the six-minute walk distance, ultimately leading to better survival rates. It is hoped that BLVR will help severe COPD patients break free from the negative spiral of COPD, maintain their quality of life, and ultimately contribute to reducing COPD-related mortality.