Breathe again: New severe emphysema treatments

Consultants at RB&HH have provided patients suffering from chronic emphysema with a new lease of life thanks to innovative new treatment options.

Emphysema is a long-term progressive disease of the lungs that causes
difficulty in breathing. It is included in a group of diseases called Chronic Obstructive Pulmonary Disease, or COPD. In emphysema, there is damage to the lung tissue which can lead to the lungs becoming over inflated. Common symptoms of emphysema are difficulty breathing, coughing, fatigue and weight loss.

Penny, 63, found she was breathless and struggled doing everyday tasks. “I was very breathless before surgery. It affected my whole life. Prior to surgery I had to use oxygen all the time.” She was diagnosed with emphysema nine years ago.

Generally, treatment for patients with emphysema include pulmonary
rehabilitation advice (guidance on smoking cessation, patient and carer
education, exercise training and breathing retraining) and use of inhaled or oral bronchodilators and glucocorticoids.

For those with more advanced disease, lung volume reduction surgery or lung transplantation may be indicated. However, recent advancements in
treatment of emphysema have brought to the forefront minimally invasive
alternatives to thoracic surgery.

Endobronchial Valves

One of the newest options for treating emphysema is the endobronchial valve. This is an implantable device designed to obstruct bronchi in diseased regions of the lung and to allow for the expiration of air from the treated lobe of the lung. When used for the appropriate patients, endobronchial valves reduce hyperinflation which allows the patients’
relief from their breathlessness

The valves are inserted into selected airways (three or four valves are usually inserted). They are designed to prevent air inflow during inspiration but they allow air and mucus to exit during expiration. This
prevents air entering the diseased parts of the lung, which then collapses so it is no longer in the way of the healthy lung.

Insertion of endobronchial valves is done with the patient under sedation or general anaesthesia and can take as little as 15 minutes. Using a delivery catheter passed through a bronchoscope, a synthetic valve is placed in the target location and fixed to the bronchial wall. Patients may sometimes be given antibiotics and/or steroids after the procedure.

Penny found the treatment changed her life. “Initially there wasn’t much change for the first few weeks. Then suddenly, I didn’t need the oxygen anymore. Only if I go to the gym for pilates.”

Lung volume Reduction Coils

Another new innovative service was launched at the Royal Brompton &
Harefield Hospitals in London earlier this year. Lung volume reduction coils are implanted into the diseased parts of the patient’s lung during a minimally invasive procedure, typically taking only 30- 45 minutes per procedure. Treatment involves two separate procedures, for each lung, four to six weeks apart.

This treatment helps to reduce over-inflation of the lungs in severe emphysema patients, resulting in a reduction in difficult or laboured breathing.

During the procedure PneumRx® coils are used, which are made of a shape-memory material called Nitinol, common in medical implants such as heart stents. The PneumRx® coils are implanted into the airways via a catheter, and once in place are designed to gently regain their shape, gathering up loose, inelastic lung tissue and holding open surrounding airways. Ten or more coils are placed at each procedure to tighten the entire airway network and achieve the optimal effects.

The coils improve a patient’s lung function in three ways: firstly, they compress diseased tissue, which provides room for healthier tissue to function; secondly, they re-tension portions of the lung involved in gas transfer, helping to increase the lung’s elasticity, which may enable the lung to more efficiently contract during the breathing cycle; finally, the coil tethers open small airways, preventing airway collapse during exhalation.

Lung Volume Reduction surgery (LVRS)

LVRS is an operation which removes the worst affected areas of the lung so that the healthier parts of the lung can work better. Also, by removing the ‘swollen’ air spaces, less air is trapped so the chest and diaphragm can relax down to a more normal level and breathing is more comfortable.

A surgeon will make a cut in one side of the chest to use a special tool to cut and staple the lung at the same time. This will seal it and prevent or reduce any air leaks. Patients will be given a general anaesthetic and will stay in hospital for about seven to 10 days to recover.

Lung volume reduction surgery can help patients live longer, increase ability to exercise and improve quality of life, compared with people who don’t have the operation.

This is a significant operation and it does carry a risk of complications that could be life-threatening. This is why people will only be selected as suitable for this operation if they meet certain criteria. It can also mean a long stay in hospital to recover from the operation.

LVRS is only a suitable treatment for a minority of people who have COPD. It is only effective for emphysema and you may not be suitable if you have other lung conditions such as bronchiectasis and asthma.


At a glance

Procedures
Endobronchial valves, Lung volume reduction coils, Lung volume reduction surgery


Carried out by
Dr Samuel Kemp, Professor Pallav Shah, Mr Simon Jordan


What problems does it solve?
This offers a suite of treatments that can be tailored to each individual patient to improve quality of life, lung function, and survival in patients with severe emphysema.


How does it work?
Endobronchial valves: Used to restrict airflow to diseased areas of the lung.


Lung volume reduction coils: Coils used to reduce overinflation of the lungs.


Lung volume reduction surgery: Operation used to remove the worst affected areas of the lung so that the healthy areas can work better.



Dr Samuel Kemp
Consultant Respiratory Physician

 

 

 

 

 

Professor Pallav Shah
Consultant in Respiratory Medicine

 

 

 

 

 

Mr Simon Jordan
Consultant Thoracic Surgeon