Endobronchial valves in the treatment of patients with severe COPD

Patients with severe COPD (emphysema) for which no treatment was possible, may have huge health benefits in response to a relatively minor procedure. The study, conducted at the University Medical Center Groningen, which was led by GRIAC (Groningen Research Institute for Asthma and COPD) researchers Dr. Dirk Jan Slebos (pulmonologist) and Karin Klooster (researcher), was published today in the leading scientific magazine The New England Journal of Medicine.

The daily lives of patients with severe COPD are severely restricted due to breathlessness. They cannot work, have a great need for care and experience a very poor quality of life as a result of continuous dyspnea. For most patients, there is hardly an effective treatment available. The treatment for COPD patients includes bronchodilators, pulmonary rehabilitation, smoking cessation and possibly oxygen. Only a very small group qualifies for a highly invasive surgical procedure in which a portion of the damaged lung is removed, or the most radical treatment: a lung transplantation. The new, less invasive treatment for patients with severe COPD may present an outcome. Over 350,000 Dutch people have COPD, and an estimated 6500 of them die each year from this disease.

This treatment is intended for people who have severe COPD characterized by emphysema. In patients with emphysema, in the most affected areas lung tissue may be severely damaged or even have completely disappeared. This causes the inhaled air to be exhaled with greater difficulty resulting in shortness of breath for the patient. By closing off the damaged part of the lung, the inflated lung volume will decrease. This reduction in lung volume creates a significant decrease in dyspnea for ​​the patient. This is because the breathing muscles are used much better with a smaller lung volume. The damaged part of the lung is closed with small endobronchial valves. As a result, the air may flow out of the damaged part of the lung, but new air cannot flow in.

The endobronchial valves are placed with the aid of a bronchoscope that is introduced into the damaged part of the lung. The relatively minor procedure is called bronchoscopic lung volume reduction, lasts forty five minutes only and takes place under general anesthesia.

With this study, it has been demonstrated for the first time that this treatment is effective for COPD patients with emphysema. The treatment was effective for 75% of patients. Among these patients there was a significant improved pulmonary function and exercise capacity. Their quality of life increased enormously. The treatment also has side effects. Due to the desired volume decrease a collapse of the lung can occur in one in five patients. The researchers hope that this study will contribute to the inclusion of this treatment in the standard of care for COPD and will be reimbursed by health insurance companies. They stress that, given the specialized nature of this treatment, it is wise to carry it out alone in a COPD center of expertise.

The research was made possible through a financial contribution from ZonMW and the innovation fund of the UMCG.

Read the article in the New England Journal of Medicine

Watch the video.

Source: press release UMCG, phone +3150361 2200