During the ERS International Congress 2023, Dr. Ngai, Chun-Li, Jenny from the Division of Respiratory Medicine at the Chinese University of Hong Kong presented a study on the efficacy of autologous blood patch therapy (ABPT) in patients with persistent air leak (PAL) of secondary spontaneous pneumothorax (SSP).¹

PAL of SSP is defined as an air leak for ≥5 days and leads to significantly increased morbidity including prolonged hospital stay, patient discomfort and associated mortality.¹ Surgery is the preferred treatment choice for PAL, but most patients with chronic lung disease are old and not suitable candidates for surgical therapy.¹ Up till now, non-surgical treatment remains unavailable for these patients.¹ ABPT is a simple and cost-effective procedure that can potentially help patients by reducing hospitalization and associated complications.¹ ABPT was shown to be successful in some studies, mainly in patients who have PAL following lung resection.¹ However, data on the effectiveness of ABPT in PAL with SSP remains inconsistent.¹ Therefore, a prospective multicenter study was conducted over 3 years to determine the efficacy of ABPT in reducing air leaks in patients with SSP and PAL ≥5 days.¹

Digital quantification has made it possible to assess treatment strategies, such as ABPT, in patients with PAL.¹ In this study, the innovative Thopaz digital chest drainage system was used to precisely measure air leak levels for a period of 48 hours before and 24 hours after ABPT.¹ Additionally, blood was withdrawn from the patients and instilled into the pleural cavity to further assess the impact of the treatment.¹ The patient’s bed position was changed every 10 minutes during the two-hour infusion period to allow the distribution of the blood over the visceral pleura.¹

Among the 32 patients with SSP and PAL enrolled, 29 received one dose of ABPT and 3 received two doses.¹ Almost all included patients were males and had a mean age of 71.4 years with the majority (88%) having chronic obstructive pulmonary disease (COPD).¹ After receiving one dose of ABPT, there was a significant decrease in the rate of air leaked at 24 hours from 192.5 [Interquartile range (IQR): 65-453] to 71.5mL/min (IQR: 21.5mL/min-278mL/min) (p<0.0001).¹ Almost 30.3% of patients had >50% reduction in air leak and 24.2% had >80% reduction and successful chest tube removal within 48 hours.¹ In addition, there were no significant side effects and none of the patients received surgery.¹

In summary, the occurrence of air leaks in SSP patients with PAL was significantly reduced with the use of intrapleural ABPT, which has been shown to be safe and effective.¹ However, further randomized trials are needed to confirm the efficacy and safety of ABPT in this patient population.¹