December 1, 2021

Advanced treatment options for emphysema

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A new emphysema treatment option using the Zephyr Valve takes a less invasive approach to lung volume reduction.

Emphysema is a form of chronic obstructive pulmonary disease in which the lung’s tiny air sacs, or alveoli, become damaged. Healthy alveoli expand and shrink like small elastic balloons. But for the estimated 3.5 million adults in the U.S. diagnosed with emphysema, air gets trapped in open spaces left behind after millions of normal air sacs are destroyed, leaving less room for air when inhaling.

“With emphysema, the lung becomes hyperinflated,” explained Robert Lentz, M.D., an interventional pulmonologist at the Vanderbilt Lung Institute. “That happens because you have big open spaces of destruction where air can sit, which causes less elastic recoil in the lung to help get air out.” As a result, patients with emphysema can hold two or three times as much air in their lungs after they maximally exhale than those with healthy lung tissue, Lentz added.

Surgical emphysema treatment, like lung volume reduction surgery or bronchoscopic lung volume reduction with valves, can reduce the amount of trapped air, which then improves the mechanics of breathing. The latter option is a less invasive procedure for the right candidates.

Lung volume reduction surgery

Lung volume reduction surgery was first used as a form of emphysema treatment in the 1950s. “When you have this hyperinflation, this air trapping, the lungs physically get bigger.” Lentz explained. “They can’t really push the ribs out very far. And so, as a result, the only recourse they have is to push the diaphragm down.” This limits how much the diaphragm can move up and down during breathing, and a patient becomes short of breath.

“When you remove a lobe or part of a lung that is particularly overinflated with extra air, the diaphragm is able to come back up to its normal configuration and work normally again,” he said. “And that causes symptom relief in quite a few people.”

Lung volume reduction surgery benefits a select group of patients. “But it’s a big surgery for patients who have end-stage organ disease,” Lentz said. “It is a good option for the right patient, but some aren’t interested in undergoing such a large procedure with upfront risk.” Valves offer an alternative.

Bronchoscopic lung volume reduction with valves

Valve placement helps accomplish lung volume reduction without the removal of lung tissue. A device called the Zephyr Valve is inserted using a bronchoscope, a small tube with a camera. The one-way valve then blocks the damaged lobe, and the section shrinks to a fraction of its former size.

“By collapsing those bad parts of the lungs we’re taking all that pressure off the chest wall, and all those muscles, and letting the patient’s normal respiratory cycle function more effectively,” said Michael Lester, M.D., at the Vanderbilt Lung Institute. Lester said about two-thirds of patients feel less short of breath and can walk farther after the procedure. They also have improved results on lung function tests.

The Food and Drug Administration (FDA) approved Zephyr in 2018. The right candidates for the surgery typically are on maximal inhaler therapy but are still limited in performing normal daily activities, Lester said.

“But for people who are very sick and feel like they’re out of options, some of them do very well after valve placement,” he added. “And it allows them to be more functional and have a higher quality of life than they would otherwise have.”

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The Vanderbilt Lung Institute brings together experts in diagnosing and treating lung disease from pulmonary medicine, thoracic surgery and allergy. This unique approach gives hope through coordinated, personalized and compassionate care for even the most complex conditions that affect the lungs and breathing.

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