. 2022 Jun 20;28(2).

doi: 10.7196/AJTCCM.2022.v28i2.249.

eCollection 2022.

C F N Koegelenberg Academic Hospital, Cape Town, South Africa.” href=”#affiliation-1″ ref=”linksrc=author_aff”>
R N van Zyl-Smit 
K Dheda 
B W Allwood Academic Hospital, Cape Town, South Africa.” href=”#affiliation-1″ ref=”linksrc=author_aff”>
M J Vorster 
D Plekker 
D-J Slebos 
K Klooster 
P L Shah 
F J F Herth 
Assembly on Interventional Pulmonology of the South African Thoracic Society


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C F N Koegelenberg et al.

Afr J Thorac Crit Care Med.



Chronic obstructive pulmonary disease (COPD) remains one of the most common causes of morbidity and mortality in South Africa. Endoscopic lung volume reduction (ELVR) was first proposed by the South African Thoracic Society (SATS) for the treatment of advanced emphysema in 2015. Since the original statement was published, there has been a growing body of evidence that a certain well-defined sub-group of patients with advanced emphysema may benefit from ELVR, to the point where the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines and the United Kingdom National Institute for Health and Care Excellence (NICE) advocate the use of endoscopic valves based on level A evidence. Patients aged 40 – 75 years with severe dyspnoea (COPD Assessment Test score ≥10) despite maximal medical therapy and pulmonary rehabilitation, with forced expiratory volume in one second (FEV1) 20 – 50%, hyperinflation with residual volume (RV) >175% or RV/total lung capacity (TLC) >55% and a six-minute walking distance (6MWD) of 100 – 450 m (post-rehabilitation) should be referred for evaluation for ELVR, provided no contraindications (e.g. severe pulmonary hypertension) are present. Further evaluation should focus on the extent of parenchymal tissue destruction on high-resolution computed tomography (HRCT) of the lungs and interlobar collateral ventilation (CV) to identify a potential target lobe. Commercially available radiology software packages and/or an endobronchial catheter system can aid in this assessment. The aim of this statement is to provide the South African medical practitioner and healthcare funders with an overview of the practical aspects and current evidence for the judicious use of the valves and other ELVR modalities which may become available in the country.


Coils; emphysema; endoscopic lung volume reduction; valves.

Conflict of interest statement

Conflicts of interest: FJFH, D-JS and PLS have treated patients in clinical trials, sponsored by PneumRx/BTG (USA), Pulmonx (Switzerland) and Spiration (USA). The rest of the authors have nothing to declare.

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Position statement on endoscopic lung volume reduction in South Africa: 2022 update