Vocal cord paralysis as a rare complication of bronchoscopic lung volume reduction: a case series of five patients

Lung volume reduction is now standard of care for symptomatic hyperinflated patients with chronic obstructive pulmonary disease (COPD) and emphysema whenever significant breathlessness persists despite maximal bronchodilation and pulmonary rehabilitation [1]. Since treatment options are limited in this context, removal of the most emphysematous parts of the lungs was initially validated surgically. Nonetheless, the benefits of surgical resection are tempered by significant morbidity [2]. Therefore, several endoscopic techniques were developed for lung-volume reduction using minimally invasive bronchoscopic approaches, such as the endobronchial valves that reduce the airflow to the most damaged lobes, endobronchial coils that mechanically reduce the lobe volume, and other techniques such as vapor-ablation or polymer foam. Most randomized controlled trials have studied endobronchial valves and coils [3–6] showing improvement in forced expiratory volume in 1 s (FEV1), in the 6-minute walk test (6MWT) distance, and quality of life. Endobronchial valve therapy is now the most used technique worldwide with more than 25 000 patients treated globally (number provide by manufacturer). The most common complication of these procedures remains, by far, pneumothorax (up to 25% of the procedures in the IMPACT trial). Other more rare complications include pneumonia, COPD exacerbation, respiratory failure, valve migration, and hemoptysis [7]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: KK reports lecture honoraria from PulmonX and Chiesi; outside the submitted work. Conflict of interest: FJH reports advisory board participation with and lecture fees from PulmonX, Uptake Medical and Olympus Medical; outside the submitted work. Conflict of interest: DJS is an advisor and principal investigator for PulmonX Corp., Redwood City, CA, USA. Conflict of interest: All other authors have nothing to disclose.