24 million Americans suffer from some form of COPD. It’s now the third leading cause of death in the U.S. Now, a new device may help these patients live longer and breathe easier.
Charlene Kelly may have to schlep an oxygen tank, but she says breathing is actually easier these days.
“I can feel that my breathing has improved over the last four years,” Charlene told Ivanhoe.
That's because of a new intra-bronchial airway valve. A flexible tube with a camera at the end of it helps to guide a small, umbrella-shaped valve inside the airways of her lung. The device redirects air from unhealthy to healthy parts of the lung.
“I definitely feel like we've helped some people have much better lives,” Kyle Hogarth, MD, Director of Bronchoscopy and Assistant Professor of Medicine, The University of Chicago, told Ivanhoe.
Charlene says prior to getting the IBV her emphysema prevented her from doing, well, almost anything really.
“I didn't sleep well. I’d wake up in the morning and I would be as tired as I was went to bed,” Charlene said.
Despite her discomfort, traditional surgery to remove the damaged parts of her lungs was just too risky and the downtime is intense.
“The recovery time for a lung surgery is weeks. The recovery time for a bronchoscopy is a day,” Dr. Hogarth said.
This new valve will last for about 14 years.
“Ten years from now we'll go and replace them for her, maybe we'll have even better technology then. Oh heck I hope by then I'm growing lung, I’ll just give her a new lung,” Dr. Hogarth said.
Risks associated with the new lung valve include pneumonia and irritation that causes coughing and excess mucus. Doctors say the valve can be easily removed if patients experience these symptoms.
The new lung valve is entering into its final phases of trial in the U.S. and it’s already being used in Europe.
BACKGROUND: Chronic obstructive pulmonary disease, or COPD, is a cluster of lung diseases that block airflow when exhaling, making it very difficult to breathe. There are two main conditions that make up COPD: chronic asthmatic bronchitis and emphysema. Many people have both. Chronic asthmatic bronchitis causes narrowing of the airways that lead to the lungs and inflammation, making the patient wheeze and cough. Emphysema damages the tiny air sacs in the lungs. It gradually destroys the inner walls of the air sac clusters, reducing the amount of surface area available to exchange oxygen for carbon dioxide. Shortness of breath will occur because the chest wall muscles have to work harder to exhale. Most COPD is the result from long-term smoking. Damage to the lungs can’t be reversed. So, treatment aims to control symptoms and minimize further damage. (Source: http://www.mayoclinic.org/diseases-conditions/seo/basics/definition/CON-20032017)
SYMPTOMS: Symptoms don’t appear until there is a great deal of lung damage. Patients with COPD are also likely to experience exacerbations when symptoms worsen over time. Symptoms will vary because there are different lung conditions that form COPD. Most people will have at least one, but usually more than one, of these symptoms: shortness of breath, chronic cough, wheezing, and chest tightness. Complications can occur with COPD; respiratory infections, high blood pressure, heart problems, and depression. (Source: http://www.thoracic.org/clinical/copd-guidelines/for-patients/what-are-the-signs-and-symptoms-of-copd.php)
NEW TECHNOLOGY: Currently in clinical trials, the intra-bronchial airway valve (IBV) is designed to help those suffering from COPD breathe easier. The IBV is a small, umbrella-shaped valve which, when in place, helps redirect air from unhealthy parts of the lung to more healthy parts. So far in the trials, those with the valves have shown improved lung function, less shortness of breath, and improved quality of life. The procedure can take anywhere from 20 to 40 minutes, followed by a 24 hour recovery period at home. The valves can also be easily removed. (Source: http://clinicaltrials.gov/show/NCT01812447 and Dr. Kyle Hogarth)
FOR MORE INFORMATION, PLEASE CONTACT:
Dr. Kyle Hogarth
Director of Bronchoscopy and Assistant Professor of Medicine
University Of Chicago
Dr. Kyle Hogarth, Director of Bronchoscopy and Assistant Professor of Medicine, University Of Chicago, talks about a new procedure for emphysema.
Can you tell me about this new procedure?
Dr. Hogarth: People with very advanced emphysema are all on various inhalers. They’ve done the appropriate exercises and quit smoking, but for a significant number of people that’s still not enough and they’re very short of breath. Years ago a surgery was developed that in a very specific type of patient you could actually do a surgery were you cut out parts of the lung that essentially weren’t working. You can think of it as pruning a tree. The surgery showed in the right patient that it does work. It had obviously one downside, it was a major surgery on an unhealthy population. So several people tried to replicate what the surgery does of pruning the tree, but doing it from the inside.
So when was the first procedure done?
Dr. Hogarth: A couple of years ago. The last trial ended three years ago.
How have those patients been doing?
Dr. Hogarth: They’ve been doing actually quite well. What I will say is that for a lot of these patients this procedure is very easy to tolerate. The nice thing about these valves is they are also removable. So everybody responds to everything differently. Let’s say I put them into you and you were the ideal candidate, but for whatever reason they’re not reacting well with your body and you’re getting pneumonia or you’re coughing. If that happens, we simply remove them, and then we are done. What’s great about them is they are meant to be implanted and they stay in and they are anchored in, but they’re also very easy to remove.
What are the side effects?
Dr. Hogarth: Well, any time you’re putting a foreign object into your body and into the lung there’s always a risk for pneumonia no matter what. It also can be an irritant, so maybe there’s some coughing, and some people have noticed more mucus. These are all very uncommon. The majority of people obviously tolerated terrifically, but unfortunately there’s always going to be somebody who’s got a negative response in some capacity or sometimes people also change their minds.
What does the beneficial response look like?
Dr. Hogarth: The beneficial response typically is improved lung function, a better exercise capacity, and a less sense of shortness of breath when you exercise. So, it is the kind of things that patients care about. They want to breathe better and they want to get around better. They know they’re going to still have limitations, but they’d like to have less of those. They know they’re still going to need their inhalers and their medication, or their oxygen, but they don’t want to have to feel as limited. These devices were developed because you had a type of patient who was already doing everything we’ve asked them to do. They’ve taken all their inhalers and they’re wearing their oxygen; they’re doing everything. The problem is that the lungs are damaged enough that we only have so much that we can do with the medications. That was why the surgery originally got developed. There had to be something else to offer people.
What is emphysema?
Dr. Hogarth: Emphysema is a destructive disease of the lungs. Your lungs are almost like a sponge, and in emphysema you’re breaking down all those various branches and pores within the sponge. The sponge then becomes loose, and hyper expanded and larger. Now envision that same sponge having it be very difficult to squeeze it out. So, what happens for people with emphysema is they can take a breath in, but then they can’t ever blow that air out. When you start to get that stretched out feeling it hurts. The disease robs you of your exercise capacity because when you go walking all of us breathe ever so slightly faster. If you have normal lungs you don’t even notice this, but if you are already adapting to get by just to breathe at rest, the active walking becomes something you’re not even able to do. The medications try to do a couple of things: they try to help open the air passages more and they try to help control the inflammation that drives this disease state. They work really well. We have good drugs for COPD and emphysema, but in some people it’s not enough. So, because this destructive nature of emphysema is not uniform on every patient for reasons that are not well understood there are some people who have different distributions of where the destruction is located. If you look at their entire lung from top to bottom, for some people its pure emphysema. However, there are other people where the emphysema is very unequally distributed and that one part is much worse than the other; that there’s still, for lack of a better word, some “good lung” in another zone whereas another part of the lung is almost “dead”. That dead part still takes up a ton of room and can squish/squeeze the healthy parts. And remember, the lung’s got to expand and move to breathe.
What causes emphysema?
Dr. Hogarth: Emphysema is caused by a multitude of factors. The most common being that people will obviously think of smoking and direct smoking and secondhand smoke obviously are involved in emphysema development. There is also a genetic condition called alpha-1 antitrypsin deficiency that’s actually more common than people think that actually predisposes you to emphysema development. There are other genetic factors that are not well understood. There’s obviously secondhand smoke, pollutions, and recurring infections.
What’s the downtime of the procedure?
Dr. Hogarth: Once you are sedated for the procedure, we’re inside your long working for anywhere from 20 to 40 minutes. Then, we pull the scope out and you go to recovery, per the protocol you spend the night in the hospital simply because it is a clinical trial and we want to watch you overnight. The recovery time is maybe an additional 24 hours at home. Then, you are back on your feet ready to go. That is obviously markedly different than having your chest cut open, lying in bed for several days, tubes between your ribs, and being in significant amounts of pain. The recovery time for a lung surgery is weeks. The recovery time for a bronchoscopy is a day.
So, how has the patient been doing?
Dr. Hogarth: Well I don’t want to put words in her mouth, but she will say the word great. She’ll say the word great. There’s been improvement in lung function and in lung capacity.