Introduction: Endoscopic lung volume reduction (ELVR) with valves (EBV) is a treatment option for COPD patients suffering from lung emphysema. So far, little is known about bacterial biofilms on EBVs and their impact on ELVR outcome. 

Methods: We analyzed clinical and microbiological data from ten patients with EBV removal. For visualization of the microorganisms EBVs were analyzed by Fluorescence in situ hybridization (FISH) in combination with PCR and sequencing (FISHseq).

Results: Figure 1 shows clinical findings, EBV cultures and FISHseq results. FISHseq revealed on 5/10 EBVs a biofilm with different bacteria. All patients with biofilm presented with recurrent exacerbations.

Conclusion: These findings show that biofilm formation on EBV might be a potential cause of recurrent exacerbations. Conventional EBV cultures were inadequate for diagnosis of bacterial biofilm. Advanced microbiological techniques can improve diagnostic to prevent further clinical consequences for patients with ELVR.