New Treatment Improves Breathing in COPD, Without Surgery
A new treatment option at Einstein Healthcare Network offers relief for some patients suffering from severe shortness of breath caused by chronic obstructive pulmonary disease (COPD).
In October, the first patient received the treatment, known as bronchoscopic lung volume reduction (BLVR) at Einstein Medical Center Philadelphia, says Sadia Benzaquen, MD, who performed the procedure. It also is sometimes called endoscopic lung volume reduction.
The patient is doing well and feeling much better, says Dr. Benzaquen, network Chair of Pulmonary, Critical Care and Sleep Medicine.
“The difference is amazing,” he says. “This patient couldn’t even go to the bathroom because of shortness of breath. But after he was telling me that he wanted to start running and walking around. I said, ‘You need to take one step at a time.’”
Trapped Air in Lungs Impairs Breathing
Emphysema, one component of COPD, attacks the air sacs in the lungs, causing them to be more elastic so patients have trouble pushing air out of the lungs. This causes what is called lung hyperinflation.
“They have air trapped,” Dr. Benzaquen explains. “And they cannot blow it out because the mechanical function of the lungs is impaired, the diaphragm is usually flat and they don’t have enough lung recoil force to let all the air blow out from the lung.”
The primary symptom of hyperinflation is shortage of breath.
For many years, thoracic surgeons have been treating this problem with lung volume reduction surgery. But it’s major surgery, and not everyone qualifies for it.
BLVR is a less invasive option. For appropriate patients, it offers a shorter procedure time and hospital stay than would occur with surgery.
Valve Releases Air, Shuts Off Diseased Area
The procedure involves inserting special valves in one hyperinflated lobe of a lung. The doctor inserts a bronchoscope down the throat to place the valves, usually in multiple branches of the airways.
The valves expand, shutting off the hyperinflated parts of the lungs. They allow trapped air to escape but prevent more air from coming in. This restriction allows air to flow better into healthier parts of the lungs, improving breathing.
“The recoil of the lung is going to be better, and certainly the lung function and the symptoms are going to get better,” Dr. Benzaquen says.
The Food and Drug Administration (FDA) has approved two BLVR valves, with different designs but similar function, since 2018.
Dr. Benzaquen came to Einstein in 2019 from the University of Cincinnati Medical Center. Although this is the first procedure Dr. Benzaquen has done at Einstein, he was part of the clinical trial that led to approval of one of the valves, called Spiration®, when he practiced in Cincinnati.
Better Breathing, Exercise and Quality of Life
“We proved that the forced expiratory volume per second [FEV1] improved significantly in patients that got the valve,” he says. FEV1 measures how much a person can exhale during the first second of a forced breath.
“Exercise capacity got better,” he adds. “Quality of life got better. And the breathlessness, the perception of shortage of breath, got better.”
Dr. Benzaquen says he used the Spiration valve, made by Olympus, on the Einstein patient. The other valve type, known as Zephyr®, is made by Pulmonx. Studies so far show the benefits of the two types are similar overall.
The valve procedure can be very helpful, but it’s not for everyone, Dr. Benzaquen notes. “They need to have severe heterogeneous emphysema, and you need to make sure the patient can tolerate the procedure.”
Each lung is divided into sections, called lobes. Dr. Benzaquen said for this surgery to be beneficial, the lobes in the treated lung should not communicate – allow air to flow between them. “If we have that collateral ventilation, it’s not going to work.”
Cautions and Complications
Although generally safe, the BLVR procedure does have potential complications. The most common one is pneumothorax, also called collapsed lung, which happens in up to half of patients who receive the procedure. A pneumothorax occurs because of the rapid shift in air volume between the treated lobe and the untreated lobe.
Normally, a BLVR patient would have to stay in the hospital at least a day or so. With a pneumothorax, more time would be required to treat the complication.
Einstein’s first patient did have a pneumothorax and ultimately spent about two weeks in the hospital, Dr. Benzaquen says. He then went into MossRehab for about a week before going home.
Although a pneumothorax requires more time in the hospital, “it’s usually a sign that the patient is going to have a good response to the procedure,” Dr. Benzaquen says.
By removing air from the hyperinflated lobe, the valves allow better breathing from the rest of the lungs.
“Keep in mind that the area that we are selecting is usually the area of the lung that is the sickest,” he Benzaquen says. For the right patients, he says, “placing the valve is the way to go.”
Learn more about lung disease care at Einstein.
Photo credit: Image used with permission. ©2018 Olympus America Inc. All rights reserved.
