• Shiyue Li, Guangfa Wang, Changhui Wang, Xinglin Gao, Faguang Jin, Huaping Yang, Baohui Han, Rui Zhou, Chengshui Chen, Liangan Chen, Chunxue Bai, Huahao Shen, Herth Felix J F FJF Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany., and Nanshan Zhong.
• The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
• Respiration. 2019 Jan 1; 97 (5): 416-427.

BackgroundChronic obstructive pulmonary disease (COPD) has become a leading cause of morbidity and mortality in China, with tobacco smoke, air pollution, and occupational biohazards being the major risk factors.ObjectivesThe REACH trial is a multicenter, prospective, randomized controlled trial undertaken in China to assess the safety and effectiveness of the Spiration® Valve System (SVS) compared to standard medical care in COPD patients with severe emphysema.MethodsPatients with severe airflow obstruction, hyperinflation, and severe dyspnea with interlobar fissure integrity were evaluated for enrollment. A total of 107 subjects were randomized in a 2: 1 allocation ratio to either the treatment group (SVS valves and medical management) or the control group (medical management alone).ResultsThe 3-month primary endpoint showed statistically significant improvement in forced expiratory volume in 1 s in the treatment group compared to the control group (0.104 ± 0.18 vs. 0.003 ± 0.15 L, p = 0.001), with the difference being durable through 6 months. Statistically significant target lobe volume reduction was achieved at 3 months (mean change 684.4 ± 686.7 mL) and through 6 months (757.0 ± 665.3 mL). Exercise function and quality of life measures improved in the treatment group, but showed a deterioration in the control group. The serious adverse event (SAE) rate was 33% in the treatment group and 24.2% in the control group. The predominance of SAEs were acute exacerbations of COPD in both groups. There was 1 death in the control group and no deaths in the treatment group.ConclusionThe SVS represents a novel approach for the treatment of severe emphysema with a clinically acceptable risk-benefit profile.© 2018 The Author(s) Published by S. Karger AG, Basel.

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