Patients with pulmonary emphysema have breathing difficulties that can be very severe and limit their daily life. It is an irreversible condition and usually requires surgical intervention.
In this article we will discuss the implantation of endobronchial valves.
What is emphysema?
El severe emphysema It is a disease included within Chronic Obstructive Pulmonary Disease (COPD) that produces Progressive and irreversible destruction of the alveoli of the lung, mainly due to smoking.
The alveoli They are "small bags" of air that we have in our lungs where gas exchange takes place, that is, the passage of oxygen into the blood and the elimination of carbon dioxide.
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Emphysema leads to a progressive deterioration of lung function that ends up producing a chronic obstruction to airflow, the air that enters and leaves our lungs with breathing. This causes air to become trapped in the lung and not be able to escape (hyperinflation), the alveoli dilate and burst.
In less damaged areas, they are compressed and stop working, causing the lung to lose its elasticity and become less distensible due to destruction and hyperinflation. The respiratory muscles see their movement limited, which makes breathing difficult and ends up causing greater swelling of the lungs, affecting their normal functioning.
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What symptoms does it cause?
This trapped air leads to symptoms such as Chronic shortness of breath (dyspnea), reduced exercise tolerance, and poor quality of lifeDespite drug treatments, pulmonary rehabilitation and oxygen therapy, many patients with severe emphysema continue to have symptoms, so other solutions must be sought.
What are the treatments indicated for emphysema?
ENDOSCOPIC LUNG VOLUME REDUCTION TECHNIQUES (EVR)
La endoscopic lung volume reduction It is a very effective treatment for these patients. It was initially performed by surgery but mortality was very high, so for some time now it has been performed endoscopically.
The aim of this intervention is to “deflate” the lungs of the affected person, eliminating the less functional and hyperinflated areas, causing their collapse or total closure (atelectasis). When this occurs, the respiratory muscles return to their natural position and the breathing process returns to normal.
There are several types of operations, such as steam thermal ablation, implantation of coils, or endobronchial valves.
Pulmonary coils are minimally invasive implants in the form of a double loop that are placed through a bronchoscope in the airways. They are made of a material called nitinol (nickel and titanium). The function of these pulmonary coils is to keep the airways open by reducing air trapping, compress the affected areas of the lung, improving elasticity and promoting airway permeability. Source: Dr. Eva Ormaechea, Specialist in Intensive Care Medicine-
In Spain, the Bronchoscopy and Pulmonary Function Section of the Pulmonology Service of the Gregorio Marañón Hospital of the Community of Madrid has performed, for the first time, a procedure to reduce lung volume in emphysema. by steam.
This involves applying steam to the part of the lung that has been most affected by the damage caused by emphysema so that the remaining lung tissue expands and functions efficiently. This results in improved breathing and the limited quality of life of these patients with severe pulmonary emphysema.
This new technique is a great benefit for patients because it is fast and safe. In just 48 hours, unless there are complications, the patient is stable. The patient also perceives the benefits after the treatment because, by improving lung capacity, the capacity for exercise increases and, therefore, their quality of life improves, being able to return to performing daily tasks with less difficulty, thus gaining autonomy. Source: Region of Madrid
ENDOBRONCHIAL VALVE IMPLANTATION
This involves implanting valves inside the bronchus that allow air to escape, but not to enter. Thanks to this, that area of the lung gradually deflates until it closes completely.
Image: Gold Report 2020
The new 2020 report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) gives the highest evidence rating to endobronchial valves for the treatment of emphysema/COPD.
GOLD’s “A” evidence rating affirms that endobronchial valves are a proven, viable, minimally invasive treatment option for severe emphysema, a form of COPD.
What benefits does the patient find?
A patient who undergoes this treatment notices the benefits from the first moment, especially in their quality of life.
According to studies that have measured this variable, using the St. George Scale, patients who have had this treatment have shown a great improvement in their quality of life. There are also improvements in spirometry and in tolerance to effort in the 6-minute walk test, among others.
Risks of valve placement
The most frequent complication, in more than 30%, is the appearance of pneumothorax: air leak in the space between the lungs and the chest wall. This air pushes on the lung from the outside and causes it to collapse. It usually appears in the first few hours after surgery and, if treated in time, resolves in most cases.
Other less frequent complications are pneumonias or the valve may become dislodged and require further intervention.
IMPORTANT
Remember that any of these treatment options must be prescribed by a doctor, according to each particular case.
If you need more information on this topic, you can contact Our Coaches writing to us at tell us@lovexair.com
Endoscopic interventions in COPD
In this podcast of FENAER The study deals with interventions carried out by endoscopy to place valves or coils in the lungs of COPD patients that allow them to reduce their lung volume and, consequently, breathe better. These are medical applications that seem futuristic, but have already been implemented in our country for more than ten years.
Interview with the Dr. Juan José Soler, Head of the Pulmonology Department at the Arnau de Vilanova-Lliria Hospital in Valencia; and Dr. Enrique Cases, Clinical Head of Interventional Pulmonology at the La Fe Polytechnic University Hospital in Valencia, one of the specialists with the most experience in this technique.
Patients Luis Granell and María Reyes Álvarez share their experience with this type of device.
Author: Eva Maroto
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734593/pdf/10.1177_1479972316631139.pdf
https://err.ersjournals.com/content/errev/28/152/180121.full.pdf
https://www.atsjournals.org/doi/pdf/10.1164/rccm.201607-1383OC
https://www.separ.es/sites/default/files/SEPAR_enfermedades_imagen.pdf
https://www.archbronconeumol.org/es-reduccion-volumen-pulmonar-por-broncoscopia-articulo-S0300289612000105
https://www.revistadepatologiarespiratoria.org/descargas/PR_21-3_96-100.pdf
Last updated on 9 July, 2021
