• T David Koster, Karin Klooster, Ten HackenNick H TNHTDepartment of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands., Marlies van Dijk, and Dirk-Jan Slebos.
• Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.
• Expert Rev Respir Med. 2020 Dec 1; 14 (12): 1235-1247.

IntroductionBronchoscopic lung volume reduction treatment with one-way valves is an effective guideline treatment option for patients with severe emphysema. However, important challenges and adverse reactions may occur after treatment.Areas CoveredThis review summarizes the complications after endobronchial and intrabronchial valve treatment that have been described by the currently published randomized controlled trials and other relevant papers regarding the complications and its management. In case there was no relevant literature regarding these subjects, recommendations are based on expert opinion. Complications include pneumothorax, post-obstruction pneumonia and hemoptysis. Also, the treatment may not be effective due to the presence of collateral ventilation or misplaced valves. Furthermore, an initial beneficial effect may vanish due to granulation tissue formation, valve dysfunction or valve migration. Careful follow-up after treatment with valves is important. Evaluation with a CT-scan and/or bronchoscopy is needed if there is no improvement after treatment, loss of benefit, or occurrence of important adverse events during follow-up.Expert OpinionTreating severe emphysema patients with one-way valves requires continuous dedication and expertise, especially to achieve an optimal outcome and elegantly deal with the various complications after treatment.

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