Anemia Leads List of Factors That Affect BLVR Failure

Comorbidities including anemia, obstructive sleep apnea, kidney failure, and the BMI, Obstruction, Dyspnea and Exercise (BODE) index affected outcomes in patients who underwent bronchoscopic lung volume reduction(BLVR), based on data from nearly 300 adults presented at the American Thoracic Society (ATS) 2026 International Conference.

BLVR has shown potential for restoring lung function and improving quality of life among individuals with chronic obstructive pulmonary disease (COPD), who have few other options for treatment, said lead author Christopher Nemeh, MD, a fourth-year fellow at the University of Chicago Hospital, Chicago.

Although the use of BLVR for patients with COPD continues to expand, data on why some patients do well and others fail are limited, said Nemeh. “Improving patient selection will help improve procedural success rates and instill more confidence in patients undergoing the procedure,” he said.

Nemeh et al reviewed data from 259 adults with COPD who underwent BLVR at the University of Chicago and University Medical Center Groningen, Groningen, Netherlands, between 2018 and 2025.

A successful procedure was defined as sustained improvement in symptoms for at least 6 months postprocedure, with no deaths or complications that required permanent valve removal. In a logistic regression analysis, the researchers examined the effects of multiple comorbidities on procedural outcomes.

Overall, anemia showed the strongest association with BLVR failure (odds ratio [OR], 2.73; P = .023), followed by the BODE index (OR, 1.41; P = .000).

By contrast, obstructive sleep apnea and estimated glomerular filtration rate were associated with procedural success (OR, 0.269; P = .024 and OR, 0.98; P = .023, respectively). The OR for a sleep apnea diagnosis associated with BLVR success rather than failure was present in a previous pilot study, but its persistence in an expanded cohort was surprising, said Nemeh.

The area under the receiver operating characteristic curve was 0.6911, and the decision curve analysis suggests that the model might discourage some high-risk patients from undergoing BLVR, which would improve clinical outcomes, the researchers noted.

The study was limited by several factors including the retrospective design and the limited sample size, Nemeh said. A prospective study with multicenter data and a patient population in the thousands would give the researchers enough confidence in their model to begin testing its efficacy in a research setting, he said. However, the results support the impact of comorbidities on BLVR failure in patients with COPD, and the logistic regression model used in the study may allow for improved risk stratification and inform discussions with patients, he noted.

In the Clinic

Patient selection remains one of the most important challenges in BLVR, and outcomes are variable even among patients who meet established physiologic and imaging criteria, said Robert Maximos, MD, MBA, DAABIP, associate professor of medicine and director, interventional pulmonology and bronchoscopy, at University of Texas San Antonio Long School of Medicine.

“Identifying additional clinical factors that influence procedural success could help improve patient selection, provide more accurate counseling regarding expected outcomes, and potentially reduce unnecessary procedures,” said Maximos, who was not involved in the study.

The findings that overall medical comorbidity influenced outcomes was not unexpected as frailty and systemic illness often affect recovery and the ability to derive clinical benefit from advanced COPD therapies, Maximos said. “The associations of anemia, higher BODE index, and reduced renal function with poorer outcomes are biologically plausible,” he noted.

“The finding that obstructive sleep apnea was associated with greater procedural success was more unexpected and may reflect confounding factors, such as closer medical follow-up or better optimization of comorbid disease, rather than a direct protective effect,” he said.

The new study highlights the need to expand patient selection criteria for BLVR beyond pulmonary function testing and quantitative CT assessment to include the patient’s overall medical condition and comorbidity burden, said Maximos. “The composite definition of procedural success used in this study — requiring sustained symptomatic improvement while also accounting for permanent valve removal and mortality — is clinically meaningful because it reflects real-world outcomes that matter to both patients and physicians,” he said. However, “the definition differs from many prior BLVR studies that have focused primarily on physiologic or quality-of-life endpoints, so comparisons with the existing literature should be interpreted carefully,” Maximos said. Consequently, given the retrospective design and modest discrimination seen on the predictive model, the findings should be considered hypothesis-generating, and should complement, rather than replace, current guideline-based patient selection until they are prospectively validated, he said.

Prospective external validation of the prediction model across diverse practice settings would be the next step for research, said Maximos. Determining whether optimization of modifiable comorbidities, such as correction of anemia or improved management of chronic medical conditions before BLVR, can improve procedural outcomes and also would be valuable, he said. “Future studies should compare this model with existing BLVR selection criteria to determine whether it provides incremental predictive value beyond current physiologic and radiographic assessment,” Maximos added.

The study received no outside funding. The researchers had no financial conflicts to disclose. Maximos had no financial conflicts to disclose.