Chronic obstructive pulmonary disease (COPD) is diagnosed in over 900,000 Britons each year. Non-invasive endobronchial valves and coils are now giving new life to patients with emphysema.
Emphysema and bronchitis are debilitating conditions - linked to smoking, occupational exposure to chemicals, or serious chest infections - and cause breathlessness and lung inflammation for the patient.
In emphysema, there is destruction of the walls of the air sacs (alveoli) of the affected lung. This reduces the elasticity of the lung tissue, meaning air is trapped in the lung.
This trapped air can cause the lung to enlarge (hyperinflate), taking up more space in the chest and making breathing more difficult. This can result in dyspnoea (shortness of breath) and lack of exercise capacity.
Until recently, treatment options have been limited to lung reduction surgery, and in even fewer patients lung transplantation.
Innovative new treatment
Experts at Royal Brompton Hospital have been developing alternative methods for treating emphysema for the last 10 years. When it's suitable, we enrol patients on to clinical trials to get more evidence that a new treatment works in the correctly selected patients.
Now, patients are more commonly treated with endobronchial valves and coils. The procedures are performed minimally invasively, via a bronchoscopy (using a camera to look into the lungs via the mouth).
This is a novel procedure which involves placing one-way valves in the lobe of a lung in selected patients with severe emphysema.
The lung is divided into compartments (lobes) and the valves are placed in the airways of one of the lobes of the lung. The valves allow air and secretions to pass out through the valve but not back in. This may results in the lobe shrinking in volume. It may allow more healthy parts of the lung to expand and function in taking up oxygen.
Who can access this treatment?
Endobronchial valves and coils are only suitable in a subgroup of patients where their lung is over-expanded and the damage to the lung is focal, so there is some good lung to improve their function. Also the patients' damaged lung lobe has to be segregated. If it communicates with other areas of the lung (known as collateral ventilation) then the valves would not work.
To identify if a patient is suitable for lung volume reduction treatment, they will undergo a range of tests including chest x-rays, CT scans of the thorax, and lung function tests.
Benefit to patients
Professor Pallav Shah, consultant respiratory physician at Royal Brompton Hospital, has been pioneering these treatments. He has found that with endobronchial valves, the key benefits to patients include:
- decreased breathlessness
- improved exercise capacity
- improved lung capacity
- improved quality of life.
In patients who are already on maximum treatment, this procedure can provide dramatic benefits. Results also suggest that following this procedure, patients may live longer.
Professor Shah says that the main side effects are a pneumothorax, when a tear in the lung causes air to leak into the sac surrounding the lung. This leak normally heals by itself after treatment with a chest drain. In rare cases, this can be a serious or life threatening complication. Other side effects may include coughing up blood, or a flare up of breathlessness or chest infections.
Consultant physician in respiratory medicine