Background: In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume\nreduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise\ntolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD)\ntreatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an\nendobronchial valve has not been attempted in patients with giant bullae.\nCase presentation: We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous\nemphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large\nbullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually\nworsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to\ntreat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA)\nconfirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial\nvalve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patientâ??s\nsymptoms and quality of life improved markedly.\nConclusion: This case supports recent suggestions that BLVR can serve as a good alternative treatment for\nappropriately selected patients.
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