Adding to the care options for patients with advanced emphysema, the Lung Center at Brigham and Women’s Hospital now offers a new procedure to place one-way endobronchial valves into the airways of a diseased lobe. The valves offer the symptom relief of lung reduction without the risks of surgery.
Three physicians at the Lung Center currently offer the procedure: Hisashi Tsukada, MD, PhD, a thoracic surgeon who is board certified in interventional pulmonology; pulmonologist Carolyn Come, MD; and pulmonologist Majid Shafiq, MD, MPH, who this year joined the hospital’s Division of Pulmonary and Critical Care Medicine.
The valves are being viewed as a potential alternative to (or eventual replacement for) lung volume reduction surgery for qualifying patients with emphysema and hyperinflation who have not found adequate symptom relief from conventional medical therapy.
How the Valves Work
Instead of removing tissue, the lung reduction is achieved by one-way valves that block air from entering the target airways where alveoli have been damaged by the disease. The valves allow the release of air that may be trapped in the lobe due to severe emphysema and block its return, thus reducing hyperinflation, an important cause of symptoms in COPD.
Valves made by two different companies were approved by the FDA in 2018 and work similarly. For both, the valves are delivered via bronchoscopy to the target airways. Valves typically are placed in multiple locations to occlude one lobe of the lung.
Studies of both valves showed improved pulmonary function scores compared to controls that received medical management alone. The valves are intended as permanent implants but are removable if needed.
While comprehensive care within the Lung Center at Brigham and Women’s Hospital offers surgical lung volume reduction (VATS), clinician-researcher Craig P. Hersh, MD, in the Center’s COPD and Emphysema Program said the lower risk of the valves offsets any slightly lower effectiveness. The valves also can serve as a bridge to transplant or offer relief for patients with little other recourse.
“Some patients are not candidates for lung reduction or transplant. For that patient, there may be no other options. But this is an option,” added Tsukada, an early adopter of the valves, who has trained in both the Spiration® Valve System and the Zephyr® Endobronchial Valve.
Patient Care Process for Valve Implantation
Extensive patient evaluation precedes implantation of either of the two valves, which have slightly different patient criteria.
Before implantation, patients are generally are required to participate in the Lung Center’s Pulmonary Rehabilitation Program for 8 to 12 weeks to ensure that they are in the best shape possible before scheduling the valve implants. “We want to offer the intervention to patients who have the best chance of success,” said Hersh.
After the procedure, patients typically remain in the hospital for at least 3 days to monitor for complications, particularly pneumothorax.
COPD and Emphysema Care within a Comprehensive Lung Center
Patients in the hospital’s COPD and Emphysema Program benefit from comprehensive care and collaboration between pulmonary medicine and thoracic surgery that is unique to the Lung Center, including access to the largest lung transplant program in New England.
The integration of valves as a care option reflects the benefits of a multidisciplinary program, said Hersh. Along a frictionless path of “two-way referral,” patients who are evaluated and found ineligible for lung transplantation may be referred for the valve procedure. Conversely, for patients awaiting transplant, the valves may offer a new and effective bridge to transplant.
Patients undergoing any interventional technique at the Lung Center, including the valve placement, also benefit from the resources of a thoracic ICU and a thoracic step-down unit and the constant availability of a thoracic surgeon to rapidly address any complications. Emphysema patients also receive routine testing for Alpha-1 antitrypsin deficiency and have access to the Lung Center’s expertise in treating the 1 percent of emphysema patients who have this inherited condition.