Breathe again: New severe emphysema treatments
Thanks to innovative new treatments, our consultants can give chronic emphysema patients a new lease of life.
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 (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, was diagnosed with emphysema nine years ago. She found that she 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.”
Patients like Penny are first treated with pulmonary rehabilitation advice – guidance on smoking cessation, patient and carer education, exercise training and breathing retraining – and can be prescribed inhaled or oral bronchodilators and glucocorticoids.
For those with more advanced disease, it may be that they need surgery or a lung transplant. However, severe emphysema patients now have more options, thanks to recent advancements in minimally invasive thoracic surgery and procedures.
The endobronchial valve is an implantable device designed to obstruct bronchi in diseased regions of the lung. This allows air to expire from the treated lobe of the lung, reducing hyperinflation. This gives the patients relief from their breathlessness.
The procedure can take as little as 15 minutes, with the patient under sedation or general anaesthesia. Using a delivery catheter passed through a bronchoscope, a synthetic valve is placed in the target location and fixed to the bronchial wall. Three or four valves are inserted into selected airways. The valves are designed to prevent air inflow, yet allow air and mucus to exit. 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.
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,” she says.
Lung volume reduction coils
Lung volume reduction coils are implanted into the diseased parts of the patient’s lung during a minimally invasive procedure. Treatment typically takes 30-45 minutes per procedure. It involves two separate procedures for each lung, which take place four to six weeks apart. This treatment helps to reduce over-inflation of the lungs in severe emphysema patients, making it easier for them to breathe.
The PneumRx® coils are implanted into the airways via a catheter. PneumRx® coils are made of a shape-memory material called Nitinol, which is common in medical implants such as heart stents. Once in place, they are designed to gently regain their shape, gathering up loose, inelastic lung tissue and holding open surrounding airways. Ten or more coils are placed during 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 a surgical 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.
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. A surgeon makes a cut in one side of the chest and uses a special tool to cut and staple the lung at the same time. This seals it and prevents or reduces any air leaks. Patients are given a general anaesthetic and stay in hospital for about seven to 10 days to recover.
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 patients may not be suitable if they have other lung conditions such as bronchiectasis and asthma.
Dr Samuel Kemp
Consultant respiratory physician
Professor Pallav Shah
Consultant in respiratory medicine
Mr Simon Jordan
Consultant thoracic surgeon