A burst of steam to relieve emphysema
Severe emphysema patients can receive a new lease of life, thanks to an innovative new vapor ablation treatment offered at Royal Brompton & Harefield Hospitals Specialist Care.
Emphysema is a progressive lung disease that can cause shortness of breath, coughing, fatigue and weight loss. It’s a form of chronic obstructive pulmonary disease (COPD) which is responsible for 30,000 deaths annually in the UK.
Patients with emphysema have damaged alveoli (air sacs) in the lungs. Over time, the inner walls of the air sacs weaken and rupture, creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches the bloodstream.
While there is no cure, treatment can help to manage symptoms. This may include guidance on smoking cessation, influenza vaccination, patient and carer education, pulmonary rehabilitation, exercise training and breathing retraining. Patients can also be prescribed inhaled or oral bronchodilators and steroids.
But for severe emphysema patients with more advanced disease, damage to the elastic tissue of the lungs causes them to become over-inflated, as they can’t empty properly. Air becomes trapped making it much harder to breathe, with less room for fresh, oxygen-rich air to enter. Comprehensive treatment may be needed to reduce the over-inflation.
Thanks to recent advances, much of which was pioneered at Royal Brompton Hospital, patients can now benefit from a range of options.
New vapor ablation treatment
Dr Samuel Kemp is a consultant in respiratory medicine and an expert in lung disease. He regularly assesses patients and determines the most appropriate treatment – ranging from minimally invasive surgery to devices such as endobronchial valves or coils which reduce lung volume. The result is that the healthier parts of the lung can work more efficiently, which gives patients relief from their breathlessness.
The newest treatment available is Bronchoscopic Thermal Vapor Ablation (BTVA), the first personalised treatment for emphysema that allows targeted treatment of a patient’s most diseased emphysema segments whilst sparing healthier segments from being unnecessarily reduced.
“Guidelines show that anyone who has severe emphysema, who is significantly breathless after pulmonary rehabilitation, and whose lung function tests show their lungs are hyperinflated, should automatically be considered for lung volume reduction treatments,” Dr Kemp explains.
“Steam is well-suited to people who don’t want surgery and who are not suitable for valves. It may be particularly appropriate for people who have diseased tissue that is very patchy. For some people, their disease is terrible in one area, but they have relatively well-preserved lung in nearby areas. The advantage of steam is that we can be much more selective about which areas of the lung we treat.”
How it works
The procedure is quick, with the patient under general anaesthesia. Dr Kemp guides the catheter through the airways to the diseased segment and a precise, patient-specific dose of steam vapor is delivered.
An empirically derived algorithmic system works out how much thermal energy is needed, based on the lung weight, which is determined by a CT scan. The system also uses the scan of the patient’s anatomy to decide the best parts of the lung to treat.
“Steam vapor is very directable,” Dr Kemp says. “It’s much more targeted and is suitable for those where treating a whole lobe of the lung is not appropriate. With vapor, you can do a bit at a time.”
This painless vapor dose is delivered in 3 to 10 seconds, ablating the targeted portion of diseased tissue causing a natural, gradual reduction occurring over several weeks, which minimises the risk of potentially life-threatening pneumothorax.
“There’s a more gradual loss of volume, which makes it safer from a lung collapse perspective, and patients are in hospital for less time after the procedure.”
After the procedure, patients stay at the hospital for 24 hours for observation and monitoring.
“Valves, surgery and coils have quick effects. BTVA is a gradual lung tissue remodelling process. It’s likely to take six weeks for the full changes to take effect. It’s a quicker procedure – but a slower and potentially more controlled response,” Dr Kemp explains.
Research has shown that the treatment maintains lung improvement over time. The reduction of diseased overinflated lung segments allows healthier segments to become uncrowded and the diaphragm to unflatten. This means the patient can breathe more easily and have a better quality of life.
At a glance
Lung volume reduction:
Endobronchial valves, lung volume reduction coils, lung volume reduction surgery, and bronchoscopic thermal vapor ablation.
Carried out by
What problem does it solve
Improves lung function in patients with severe emphysema, leading to relief from symptoms of breathlessness and an improvement in their quality of life.
All four lung volume reduction treatments reduce the hyperinflation of the lungs.
- Lung volume reduction surgery reduces the volume and tissue of the most diseased lobes by surgically removing tissue.
- Bronchoscopic thermal vapor ablation reduces the volume and tissue of the most diseased segments of lobes by creating heat-induced tissue insult and remodelling.
- Implanting endobronchial valves into the airways reduces the volume of a diseased lobe by blocking air from entering the lobe.
- Implanting coils into the majority of airways reduces the volume of the lung by compressing lung volume.