Bronchoscopic Lung Volume Reduction
Bronchoscopic or endobronchial volume reduction is a relatively new technique and fully approved by the US FDA for selected patients with severe emphysema and hyperinflation. It entails the introduction of one-way valves into most of the disease-affected lobe, whereby air can only exit but not re-enter. This results in the decrease of volume in the treated part of the lung, lessening of symptoms, and enhancement of the pulmonary function. This enables the patients to walk for a longer distance, and perform activities of daily living and some of them have been able to be taken off oxygen.
Surgical lung volume reduction is performed under the conventional technique while endobronchial valves are done via a bronchoscopic procedure which does not require surgery, suture, or any scar at all. This avails other management strategies in patients with poor respiratory status who are candidates for surgery. For patients who meet the criteria for lung volume reduction but are not suitable for EBV placement, surgical LVRS is performed employing innovative minimally invasive methods.
Note: What is Emphysema?
Emphysema is a type of chronic obstructive pulmonary disease (COPD) marked by the deterioration of lung tissue and the development of blebs. This condition leads to compromised gas exchange and an abnormal accumulation of air within the lungs, known as hyperinflation. Such excessive air retention places respiratory muscles under mechanical strain, resulting in a gradual increase in shortness of breath. The lung volume reduction procedure is designed to interrupt the detrimental cycle of breathlessness associated with hyperinflation.
Benefits of Bronchoscopic Lung Volume Reduction
In emphysema, the respiratory tissue in the lungs is compromised and so patients cannot expel air from the lungs, which remains filled with a portion of it. As the person breathes, the lungs dilate and dilate more, trying to receive fresh air to feed the body with oxygen.
Sometimes, it is possible to help the lung to decompress by reducing the level of pressure through a procedure known as bronchoscopic lung volume reduction, it is a non-surgical procedure, which does not require any cuts or stitches. BLVR can assist individuals with severe emphysema that will not be enhanced with other typical therapies including drugs, pulmonary rehabilitation, and oxygen therapy.
BLVR enhances patients’ pulmonary function and overall quality of life through several advantages, including:
- Decreased lung volume without the excision of lung tissue
- Reduced instances of breathlessness
- Better exercise tolerance
- Enhancement in mobility specifically in walking/ climbing stairs and performing other tasks as well as improved functional status
- Less oxygen requirement
- Increase of the lung function as determined during pulmonary function testing.
- Enlargement of healthy lung areas, leading to improved respiratory function
- Possibility of airway valve removal in the event of complications
- Minimized risk of complications compared to surgical interventions
- Accelerated recovery period.
Who Is a Candidate for Bronchoscopic Lung Volume Reduction?
The most suitable candidates for bronchoscopic lung volume reduction (BLVR) are individuals who meet the following criteria:
- Are not eligible for surgical intervention
- Suffer from chronic obstructive pulmonary disease (COPD), particularly emphysema accompanied by severe hyperinflation
- Have not undergone significant lung surgeries, including lung transplantation or lung volume reduction surgery (LVRS)
- Do not present with serious cardiac issues, such as uncontrolled atrial fibrillation or a recent myocardial infarction
- Have refrained from smoking for a minimum of four months
The determination of whether BLVR or LVRS is the more fitting option will be made by the patient’s healthcare team.
Treatment With Bronchoscopic Lung Volume Reduction
BLVR is most suitable for patients who are undergoing maximum medical therapy and participating in pulmonary rehabilitation, a specialized form of physical therapy aimed at addressing lung conditions. A team of specialists conducts comprehensive evaluations for patients with severe emphysema to determine the appropriateness of BLVR for their treatment.
The evaluation process generally encompasses:
- Computed tomography (CT) scan: This advanced X-ray technology captures cross-sectional images, creating detailed three-dimensional representations of the lungs to identify areas affected by disease.
- Pulmonary function tests: These noninvasive assessments measure the airflow in and out of the lungs, evaluate the efficiency of oxygen transfer into the bloodstream, and assess lung volume.
The U.S. Food and Drug Administration has sanctioned two types of valves for use in the BLVR procedure for emphysema treatment. UT Southwestern provides both options:
- Spiration® valve system by Olympus
- Zephyr® endobronchial valve by Pulmonx.
Procedure
The interventional pulmonologists conduct bronchoscopic lung volume reduction (BLVR), a procedure characterized by its minimally invasive nature. The process of performing a bronchoscopy for BLVR generally involves the following steps:
- Before the procedure, patients are administered either sedative medications to promote relaxation or general anesthesia to induce sleep. Additionally, numbing agents are applied to the nostrils or the oral and pharyngeal regions to mitigate any discomfort caused by the bronchoscope.
- The pulmonologist carefully introduces the bronchoscope through a nostril, the mouth, or an endotracheal tube. This slender, flexible instrument is equipped with a camera at its tip, enabling the physician to visualize the airways and lungs.
- Using the bronchoscope, the physician assesses lung ventilation and strategically places small one-way valves into the airways that lead to the overexpanded areas of the lungs.
- Upon completion of the procedure, the pulmonologist withdraws the bronchoscope.
Once the valves are in place, they function to decrease lung volume by obstructing airflow into the affected regions while facilitating the expulsion of trapped air and secretions. Through BLVR, airflow is redirected to healthier lung areas, thereby enhancing their functionality.
Following the procedure, patients usually remain hospitalized for two to three days before being discharged. In contrast, conventional lung volume reduction surgery typically necessitates a more extended recovery period.
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