Bronchoscopic thermal vapour ablation for upper-lobe emphysema

To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 5 sources, which was discussed by the committee. The evidence included 1 randomised controlled trial (reported in 2 studies) and 2 case series (1 of which was reported in 2 studies), and is presented in table 2 of the overview. Other relevant literature is in the appendix of the overview.

The specialist advisers and the committee considered the key efficacy outcomes to be: quality of life and improvement in FEV₁ (forced expiratory volume).

The specialist advisers and the committee considered the key safety outcomes to be: worsening lung function, infection, bleeding and pneumothorax.

Patient commentary was sought but none was received.

The committee noted that the dose of thermal vapour for each patient is calculated by the company that supplies the vapour generator, using imaging done before the procedure.

The committee was informed that the risk of pneumothorax is lower with this procedure compared with endobronchial valves.

The committee noted that this procedure may have a role in patients with incomplete fissures.