Endobronchial valve (EBV) insertion for severe emphysema does not improve skeletal muscle mass or function: A pilot study on 19 patients.

Endobronchial valve (EBV) insertion for severe emphysema allows to reduce hyperinflation and alleviates respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD). However, few studies investigate its effect on extra-pulmonary manifestations. We sought to assess the effect of EBV insertion on skeletal muscle mass and function, as well as determine if skeletal muscle parameters could represent a prognostic factor for response to EBV insertion. We conducted a monocentric prospective pilot study including 19 patients. Exhaustive evaluation of lung & skeletal muscle parameters was performed at baseline and 3 and 6 months after EBV insertion. Our primary aim was to assess the 6-month change in skeletal muscle parameters i.e. assessment of body composition with bioimpedance analysis (appendicular skeletal muscle mass index, fat mass, phase angle), evaluation of thoracic muscles (pectoralis, erector spinal, 5th intercostalis, psoas) surfaces and densities on CT-scans, and of upper limb force with handgrip test. EBV insertion led to a significant improvement of lung function after 3 months and persisting at 6 months. In contrast, no significant improvement was observed in skeletal muscle parameters. In addition, no muscle parameter nor sarcopenic status was found to predict response to EBV insertion. These results suggest that EBV insertion is not associated with strong systemic effects in our study, as well as emphasize the need to find bottom-up drug strategies for COPD-associated sarcopenia.