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Utilização de válvulas endobrônquicas no tratamento da DPOC
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Resumo(s)
A Doença Pulmonar Obstrutiva Crónica (DPOC) é caracterizada por uma obstrução progressiva das vias aéreas, associada a uma resposta inflamatória do aparelho respiratório, com repercussões sistémicas. A sua prevalência tem aumentado, sendo uma causa importante de morbimortalidade a nível mundial, com sintomas progressivamente mais incapacitantes, que afetam a qualidade de vida dos doentes. Não existindo cura, o tratamento da doença visa o controlo e a paliação dos sintomas, a diminuição das exacerbações, o controlo das comorbilidades e a melhoria da qualidade e da esperança de vida. Inclui medidas higieno-dietéticas, vacinação, medidas antitabagismo, terapêutica farmacológica, reabilitação respiratória, transplante pulmonar e terapêutica avançada do enfisema pulmonar – cirurgia e tratamento endoscópico. Uma alternativa terapêutica promissora é a utilização de válvulas endobrônquicas, cujo objetivo é promover a atelectasia de um lobo pulmonar enfisematoso, melhorando a relação ventilação/perfusão e a hiperinsuflação. O presente trabalho visa elaborar uma revisão narrativa sobre a principal técnica endoscópica de tratamento do enfisema pulmonar: a utilização de válvulas endobrônquicas. Serão também referidos os critérios de seleção dos doentes elegíveis para beneficiar desta abordagem terapêutica. Por fim, será ainda apresentado um caso clínico de um doente sujeito a esta técnica. Em conclusão, esta técnica será comparada com outras abordagens endoscópicas, como a colocação de coils ou a aplicação de vapor, e com outras terapêuticas invasivas como a cirurgia de redução de volume ou o transplante pulmonar, para que seja possível avaliar o grau de risco-benefício de cada uma, para cada doente.
Chronic Obstructive Pulmonary Disease (COPD) is characterized by a progressive obstruction of the airways, associated with an inflammatory response of the respiratory system, with systemic repercussions. Its prevalence has increased, being an important cause of morbidity and mortality worldwide, with progressively more disabling symptoms, which affect the quality of life of patients. Since there is no cure, the treatment of the disease aims at controlling and palliating the symptoms, reducing exacerbations, controlling comorbidities and improving quality and life expectancy. It includes hygiene-dietary measures, vaccination, anti-smoking measures, pharmacological therapy, respiratory rehabilitation, lung transplantation and advanced therapy for pulmonary emphysema – surgery and endoscopic treatment. A promising therapeutic alternative is the use of endobronchial valves, whose objective is to promote atelectasis of an emphysematous lung lobe, improving the ventilation/perfusion ratio and hyperinflation. The present work aims to elaborate a narrative review on the main endoscopic technique for the treatment of pulmonary emphysema: the use of endobronchial valves. The selection criteria for eligible patients to benefit from this therapeutic approach will also be mentioned. Finally, a clinical case of a patient subjected to this technique will also be presented. In conclusion, this technique will be compared with other endoscopic approaches, such as the placement of coils or the application of steam, and with other invasive therapies such as volume reduction surgery or lung transplantation, so that it will be possible to assess the degree of risk- benefit of each, for each patient.
Chronic Obstructive Pulmonary Disease (COPD) is characterized by a progressive obstruction of the airways, associated with an inflammatory response of the respiratory system, with systemic repercussions. Its prevalence has increased, being an important cause of morbidity and mortality worldwide, with progressively more disabling symptoms, which affect the quality of life of patients. Since there is no cure, the treatment of the disease aims at controlling and palliating the symptoms, reducing exacerbations, controlling comorbidities and improving quality and life expectancy. It includes hygiene-dietary measures, vaccination, anti-smoking measures, pharmacological therapy, respiratory rehabilitation, lung transplantation and advanced therapy for pulmonary emphysema – surgery and endoscopic treatment. A promising therapeutic alternative is the use of endobronchial valves, whose objective is to promote atelectasis of an emphysematous lung lobe, improving the ventilation/perfusion ratio and hyperinflation. The present work aims to elaborate a narrative review on the main endoscopic technique for the treatment of pulmonary emphysema: the use of endobronchial valves. The selection criteria for eligible patients to benefit from this therapeutic approach will also be mentioned. Finally, a clinical case of a patient subjected to this technique will also be presented. In conclusion, this technique will be compared with other endoscopic approaches, such as the placement of coils or the application of steam, and with other invasive therapies such as volume reduction surgery or lung transplantation, so that it will be possible to assess the degree of risk- benefit of each, for each patient.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Doença pulmonar obstrutiva crónica (DPOC) Enfisema Válvulas endobrônquicas Redução do volume pulmonar Atelectasia Pneumologia