Helping Emphysema Patients Breathe Easier By Mark A. Vollenweider, MD, MPH More than 15 million Americans have some form of chronic obstructive pulmonary disease (COPD). And for the 3.5 million who suffer from emphysema — COPD’s more severe, progressive form — simply taking a breath can be a painful challenge. Emphysema weakens and ruptures the tiny air sacs in the lungs, creating larger air spaces. When this occurs, old air becomes trapped in these damaged pockets, putting pressure on the healthy parts of the lung and on the diaphragm — making it difficult to take deep breaths. Patients may struggle with normal daily activities like bathing, getting dressed, walking or even eating without feeling breathless and tired. Emphysema is life-threatening and currently has no cure. Initial treatments include medications such as bronchodilators, antibiotics and inhaled steroids. Pulmonary rehabilitation, nutrition therapy and supplemental oxygen are other approaches. For those with more serious cases of emphysema, highly invasive treatments such as lung volume reduction surgery or lung transplantation have been the traditional options.
AN ALTERNATIVE TO LUNG SURGERY With no surgical cutting or incisions needed, the Zephyr® Valve System is the first procedure approved by the U.S. Food and Drug Administration (FDA) to treat severe cases of emphysema that is minimally invasive. The valve is effective for adults who have little or no collateral ventilation (where ventilation bypasses obstructed airways through other channels) in the lobes where valves will be placed. People who have breathlessness even though they are taking emphysema or COPD medicines are candidates. Other health factors also may be taken into account. Since 2007, more than 20,000 patients have been treated with the Zephyr Valve worldwide. In June 2018, it was approved by the FDA for use in the United States. The Zephyr Valve was granted Breakthrough Device Designation by the FDA based on positive data from clinical trials, including the pivotal LIBERATE trial. Orlando Health Orlando Regional Medical Center (ORMC) was the only hospital in Florida that participated in the LIBERATE clinical trial to evaluate the effectiveness and safety of the Zephyr Endobronchial Valve in emphysema patients with little to no collateral ventilation. During the procedure, a bronchoscope — a small, flexible tube with a camera — is inserted through the nose or mouth and down into the lungs. The Zephyr system’s one-way valves are implanted to prevent airflow into the lungs’ diseased areas while allowing trapped air and fluids to escape. By reducing the lung volume, the healthy portions of the lungs can expand, and the diaphragm has less pressure, enabling deeper breaths, less shortness of breath and increased energy levels. While the Zephyr Valve does not cure emphysema and may not eliminate all symptoms of the disease, it does provide a revo12 FLORIDA MD - JUNE 2021
lutionary approach for improving the health and quality of life for patients with emphysema. Orlando Health ORMC was the first hospital in Florida to offer the Zephyr valve treatment and continues to be one of only about a dozen in Florida approved by Pulmonx, maker of the Zephyr Valve, to perform the procedure.
OPENING THE LUNGS’ AIRWAYS Prior to being approved for the Zephyr Valve procedure, patients will receive a CT scan. Using the StratX® Lung Analysis Platform, a cloud-based CT analysis service, the surgeon is provided information on where the dense portions of the lung are and where the damaged portions are. The damaged portions of the lung are where valves need to be placed to obstruct airflow to those areas. Once the 30- to 60-minute bronchoscopy procedure is underway, the StratX® findings are confirmed using the Chartis® Pulmonary Assessment System. Before any valves are put in place, catheters with balloons are inserted to obstruct the targeted lobes. The Chartis System provides precise flow and pressure readings for each specific lobe to assess the absence of collateral ventilation. For example, if I am trying to obstruct the left upper lobe, when the Chartis balloon is placed in that airway I want the air flow to go down and the pressure to go up to make sure that there are no backflow leaks, or collateral lateral ventilation. This process is an important predictor of response to the valve treatment and puts the patient’s needs at the forefront before the procedure continues. During the procedure, anywhere from two to six one-way valves are placed in the designated airways to block off the diseased parts of the lungs, preventing air from entering those areas and becoming trapped. Keeping air from getting trapped in the diseased parts of the lung allows the healthier parts of the lungs to be more efficient — able to expand and take in more air. As with any medical procedure some risks exist, including pneumothorax, worsening of COPD symptoms, bleeding in the airway, pneumonia and, in rare cases, death. Patients will stay in the hospital for five days for observation following the procedure. Patients who have had the Zephyr Valve procedure may experience immediate relief. It improves quality of life by allowing patients to breathe easier, have less shortness of breath, and be more active and energetic. Whether returning to work, enjoying retirement, or celebrations in between, the outcomes can be life changing. continued on page 13
