Zephyr Valve, images courtesy of Pulmonx Corp.
Bronchoscopic lung volume reduction (BLVR) treatment for emphysema is still a relatively new procedure, only approved by the FDA in June 2018. With nearly three million Americans living with emphysema, a form of chronic obstructive lung disease (COPD), this non-invasive procedure could offer hope at an improved quality of life for these patients.
Dr. Magge, an interventional pulmonologist at Saint Francis Hospital in Hartford, Connecticut, is a specialist in the procedure. He became passionate about pulmonary and critical care medicine while doing rotations in an intensive care unit during his internal medicine residency. Once he decided on pulmonary and critical care as a fellowship, he found the subspecialty of interventional pulmonology particularly alluring and spent time learning BLVR and other advanced airway procedures at Beth Israel Deaconess Medical Center and Massachusetts General Hospital in Boston, Massachusetts. “Besides oxygen and inhalers for milder cases and more invasive procedures like lung transplant and lung surgery—which can cause a host of additional issues—this is a way to intervene and help patients who at one point we didn’t have options for,” he said.
How BLVR Works
BLVR is a minimally invasive procedure that uses a small tube with a camera, called a bronchoscope, that guides the placement of about four endobronchial valves. These one-way valves allow trapped air to be exhaled from the damaged part of the lungs and prevent inhaled air from becoming trapped. “The whole point is to basically collapse the bad part of the lung, which can be helpful for damaged lungs because the oxygen can get diverted to the healthier parts of the lung. This eases labored breathing and helps patients to feel better,” said Dr. Magge.
Dr. Magge’s patient Paul is a great example of someone who saw significant improvement. Before having the valves inserted, Paul was reliant on supplemental oxygen and unable to do some of his favorite activities, like gardening and jogging. “He could barely walk five feet without stopping to catch his breath and was basically handcuffed to his oxygen tank,” Dr. Magge said. “So, once he was approved for the procedure, we decided to target the left lower lobe, and leave the left upper lobe to compensate.”
Though the procedure is not a cure, Paul is feeling less short of breath. He is still required to go to pulmonary rehabilitation twice a week and has seen great health improvements. “Paul no longer needs oxygen therapy, or needs to use a walker, and now he is able to do all the things he loves again,” Dr. Magge said.
Is BLVR Right for You?
Before a patient can be considered for bronchoscopic lung volume reduction treatment, they are required to take a series of blood and breathing tests. A chest CAT scan is also needed to determine where the most significant lung damage is, and finally a cardiac ultrasound to determine if the patient is well enough to undergo the procedure. “Patients are recommended to me by their pulmonologists if they fit certain criteria. Ultimately, candidates should be symptomatic, but they can’t be so ill that the procedure could put them in harm's way,” Dr. Magge said.
It should be noted that the procedure does come with risk, such as a pneumothorax, so patients are monitored in the hospital for at least 72 hours, just to ensure that none of the possible complications develop. “We watch closely and continue to have outpatient check-ups once they are out of the hospital, but ultimately, I have seen great results.”
Before you can be considered for such a procedure, Dr. Magge expressed the importance of quitting smoking. If you are looking to start your quit journey, check out our Freedom from Smoking Resources.
Blog last updated: August 25, 2023