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We thank Drs. Macedo-Neto and Oliveira for their interest in our paper on the effect of bronchoscopic lung volume reduction on dynamic hyperinflation in emphysema (1). Regarding nomenclature, although we don't think that it is the most important issue, our preference remains for "bronchoscopic lung volume reduction" (BLVR), which seems to be the term most established in the literature (1–6). We would suggest that the introduction of another acronym into contention at this stage is unlikely to be helpful, and we remain unconvinced that the term "transbronchoscopic" conveys any additional meaning compared with the more popular "bronchoscopic."

On the more important issue of patient selection, we would caution that although BLVR improves exercise performance by reducing dynamic hyperinflation, we did not find that the degree of dynamic hyperinflation, expressed either in relative or absolute terms, occurring in individual patients preprocedure, predicted benefit from valve placement. Issues regarding patient selection for bronchoscopic techniques will hopefully become clearer as the results from larger randomized studies become available.

Nicholas S. Hopkinson and Michael I. Polkey

Royal Brompton Hospital, London, United Kingdom

FOOTNOTES

Conflict of Interest Statement: Neither of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Hopkinson NS, Toma TP, Hansell DM, Goldstraw P, Moxham J, Geddes DM, Polkey MI. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med 2005;171:453–460.[Abstract/Free Full Text]
2. Ingenito EP, Reilly JJ, Mentzer SJ, Swanson SJ, Vin R, Keuhn H, Berger RL, Hoffman A. Bronchoscopic volume reduction: a safe and effective alternative to surgical therapy for emphysema. Am J Respir Crit Care Med 2001;164:295–301.[Abstract/Free Full Text]
3. Ingenito EP, Berger RL, Henderson AC, Reilly JJ, Tsai L, Hoffman A. Bronchoscopic lung volume reduction using tissue engineering principles. Am J Respir Crit Care Med 2003;167:771–778.[Abstract/Free Full Text]
4. Toma TP, Hopkinson NS, Hillier J, Hansell DM, Morgan C, Goldstraw PG, Polkey MI, Geddes DM. Bronchoscopic volume reduction with valve implants in patients with severe emphysema. Lancet 2003;361:931–933.[CrossRef][Medline]
5. Snell GI, Holsworth L, Borrill ZL, Thomson KR, Kalff V, Smith JA, Williams TJ. The potential for bronchoscopic lung volume reduction using bronchial prostheses: a pilot study. Chest 2003;124:1073–1080.[Abstract/Free Full Text]
6. Venuta F, de Giacomo T, Rendina EA, Ciccone AM, Diso D, Perrone A, Parola D, Anile M, Coloni GF. Bronchoscopic lung-volume reduction with one-way valves in patients with heterogenous emphysema. Ann Thorac Surg 2005;79:411–416.[Abstract/Free Full Text]

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