New Study Identifies Emphysema-Specific Air Trapping as Key Predictor of Pneumothorax Risk After Bronchoscopic Lung Volume Reduction
By Dr. Natalie Singh
May 20, 2026 — A groundbreaking study presented at the American Thoracic Society (ATS) 2026 International Conference reveals that emphysema-specific air trapping—measured through quantitative CT scans—can predict the risk of pneumothorax in patients undergoing bronchoscopic lung volume reduction (BLVR). The findings offer a non-invasive, pre-procedural method to identify high-risk patients, potentially reducing unnecessary hospitalizations and improving clinical decision-making.
Why This Discovery Matters
Pneumothorax, or a collapsed lung, occurs in approximately one-third of patients after BLVR, a minimally invasive procedure used to treat severe emphysema. Currently, all patients undergoing BLVR are admitted for three days of monitoring post-procedure to detect this complication. The new research suggests that pre-procedural imaging could help clinicians stratify risk, allowing for more personalized care and potentially shorter hospital stays for lower-risk patients.
“This is a significant step forward,” says Isam Albaba, MBBS, a pulmonary and critical care fellow at the Temple Health Lung Center in Philadelphia and lead author of the study. “We’ve identified a measurable, physiological marker that correlates with pneumothorax risk, which could change how we approach patient selection and postoperative management.”
Key Findings: Emphysema-Specific Air Trapping as a Predictor
The study, published in the Medscape Medical News and presented at ATS 2026, analyzed data from 59 adults (median age ~68 years; over 50% male) who underwent BLVR. Researchers quantified functional air trapping (fAT)—the proportion of lung tissue retaining air between inspiratory and expiratory CT scans—and found that:
- Emphysema-specific fAT (fAT-E) was significantly associated with pneumothorax risk (P = .017), while total air trapping was not.
- Patients who developed pneumothorax showed higher fAT-E levels and a greater reduction in low-attenuation lung areas (≤ -856 Hounsfield units).
- The predictive power of fAT-E was strongest in patients with a ≥1-liter change in total lung volume between scans (AUC = 0.79 vs. 0.68 for the full cohort), suggesting this subgroup may benefit most from pre-procedural risk assessment.
“The key insight is that air trapping in emphysematous regions—not just overall air trapping—is what matters,” Albaba explains. “These areas are structurally fragile, making them more prone to injury during BLVR, which likely explains the higher pneumothorax risk.”
How Could This Change Clinical Practice?
The study’s implications are twofold:
- Risk Stratification: Clinicians could use pre-procedural CT scans to identify patients at higher risk of pneumothorax, enabling more informed shared decision-making. For example, high-risk patients might be counseled on the potential need for extended monitoring or alternative treatments.
- Reduced Hospitalization Burden: If validated in larger studies, this approach could help avoid unnecessary admissions for low-risk patients, freeing up hospital resources and reducing costs.
However, Emily DuComb, DO, DAABIP, a clinical assistant professor at the University of Michigan Medical School, cautions that more research is needed. “While the findings align with the pathophysiology of pneumothorax in BLVR, we need larger, multicenter studies to confirm these results and understand how they impact patient outcomes—such as whether pneumothorax affects recovery or the need for valve removal.”
Barriers to Implementation
Despite its promise, the study highlights practical challenges:
- Software Limitations: Many hospitals lack the quantitative CT analysis tools required to measure fAT-E, and existing algorithms vary between systems. Standardization will be critical for widespread adoption.
- Validation Needed: The proposed cutoff values for pneumothorax risk require prospective validation before they can be integrated into clinical guidelines.
Albaba acknowledges these hurdles but remains optimistic. “If we can overcome these barriers, this could become a standard part of pre-BLVR evaluation—a simple, non-invasive way to improve patient safety.”
Looking Ahead: What’s Next for BLVR and Pneumothorax Risk?
The study opens the door for several future research directions:
- Larger, Multicenter Trials: Confirming these findings in diverse patient populations will strengthen their clinical applicability.
- Postoperative Outcomes: Investigating whether pneumothorax affects long-term recovery, valve retention rates, or overall procedural success.
- Alternative Risk Markers: Exploring other imaging or physiological biomarkers that could further refine risk prediction.
For now, the takeaway is clear: emphysema-specific air trapping on CT scans may hold the key to predicting pneumothorax after BLVR. As Albaba notes, “This isn’t just about identifying risk—it’s about empowering clinicians to make better decisions for their patients.”
Key Takeaways
- Emphysema-specific air trapping (fAT-E) on CT scans predicts pneumothorax risk after BLVR, with stronger associations in patients with ≥1-liter lung volume changes.
- Current practice requires 3-day hospitalizations post-BLVR to monitor for pneumothorax; this study suggests a way to potentially reduce unnecessary admissions.
- Barriers to adoption include lack of standardized quantitative CT tools and the need for prospective validation.
- Future research should focus on larger trials, postoperative outcomes, and additional risk markers.
FAQs: What Patients and Clinicians Need to Know
Q: What is bronchoscopic lung volume reduction (BLVR)?
A: BLVR is a minimally invasive procedure used to treat severe emphysema by reducing lung volume and improving lung function. It involves placing one-way valves in the airways of damaged lung regions to prevent air from entering and trapping.
Q: How common is pneumothorax after BLVR?
A: Pneumothorax occurs in approximately one-third of patients after BLVR, making it a significant but manageable complication.
Q: Could this study change my BLVR procedure if I’m a high-risk patient?
A: While the study is promising, it hasn’t yet been integrated into clinical guidelines. If you’re considering BLVR, discuss your individual risk factors with your pulmonologist, including any pre-procedural imaging findings.
Q: Are there other ways to reduce pneumothorax risk after BLVR?
A: Current strategies include close postoperative monitoring, avoiding activities that increase intra-thoracic pressure (e.g., heavy lifting), and using supplemental oxygen as directed. Future research may identify additional preventive measures.
Q: How accurate is this new prediction method?
A: In this study, emphysema-specific air trapping had a predictive accuracy of 79% in high-risk patients (AUC = 0.79), which is considered moderate to solid. However, larger studies are needed to confirm these results.
Final Thoughts: A Step Toward Personalized Lung Care
This study underscores the growing role of personalized medicine in pulmonary care. By leveraging advanced imaging techniques, clinicians may soon be able to tailor BLVR procedures to individual risk profiles, improving safety and outcomes. For patients with emphysema, the future of lung treatment looks brighter—and more precise—than ever.
Dr. Natalie Singh is a board-certified internal medicine physician and health editor with expertise in respiratory diseases and medical innovation. She has authored peer-reviewed studies on infectious disease and serves as a medical consultant for ArchyNewsy.