EMPHYSEMA, A FORM OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), is a condition that literally takes your breath away.
Strongly associated with smoking, emphysema develops gradually due to lung tissue damage that leads to air entrapment. In essence, people with emphysema are able to inhale but cannot exhale effectively, causing the lungs to overfill and preventing proper oxygenation of the blood. As a result, they experience symptoms such as shortness of breath, coughing, wheezing, and chest tightness. Emphysema is not curable, and the condition tends to worsen progressively until patients are left with very little capacity to breathe.
UTMC pulmonologist Mohamed Omballi, MD, explains that for people with emphysema, normal daily activities can become significant obstacles. “Most of us take easy breathing for granted,” he says, “but for patients with emphysema, simple things like walking to the mailbox, cooking, taking a shower, and playing with the grandkids are major hurdles to be overcome.”
Though emphysema is not curable, treatments are available to help manage the condition, ranging from inhalers and other medications to various surgical options. One leading-edge procedure that UTMC’s interventional pulmonology team now offers for emphysema patients who have significant air trapping and haven’t achieved symptom relief with other treatments is Zephyr® Endobronchial Valve implantation.
According to Dr. Omballi, “The Zephyr Valve is a one-way valve that blocks airflow to the damaged portion of the lung while allowing air to escape. We place valves in the bronchial tubes leading to the most damaged part of the lung to divert airflow to healthy lung tissue. The damaged part then collapses, reducing the volume of the lung and allowing more space for healthy lung tissue to expand, thereby making it easier for the patient to breathe.”
The subset of emphysema patients who are considered good candidates for the Zephyr Valve are those who have significant air trapping in their lungs, have quit smoking, and continue to experience symptoms despite the use of inhalers, pulmonary rehab, and other therapies. “In other words, it’s appropriate for people with emphysema who’ve tried everything else medically but haven’t achieved good results,” Dr. Omballi says.
Zephyr Valve implantation is minimally invasive and is performed using a bronchoscope. The procedure involves no incisions or cutting and is usually done under conscious sedation, though it can also be done under general anesthesia. The patient experiences no pain during or after the procedure, and the actual implantation takes only about 30 minutes. “It’s a brilliant concept but technically very easy for a trained bronchoscopist to perform,” enthuses Dr. Omballi.
Following Zephyr Valve implantation, patients typically stay in the hospital for three days so they can be monitored for the common side effect of lung collapse and to ensure that airflow is being properly diverted from damaged lung tissue to healthy lung tissue. The maximum benefit of the Zephyr Valve is usually experienced within about six weeks, so patients are cautioned not to expect to feel significantly different immediately upon waking from the procedure.
While the Zephyr Valve has been FDA approved for only three years, approximately a decade of research has been done on the technology and has revealed significant benefits. Dr. Omballi remarks, “Studies have shown that emphysema patients who undergo Zephyr Valve placement have a better quality of life, improved lung function, and the ability to walk longer. Some have even been able to come off oxygen after the procedure.”
There are alternatives to the Zephyr Valve procedure, including surgical lung volume reduction and lung transplant. However, as Dr. Omballi points out, both approaches have their drawbacks. “Surgical lung volume reduction is a major surgery that involves making an incision, opening the chest, and an average hospital stay of one week. But with advances in technology, we can now get the same results with a minimally invasive approach and far fewer complications. With lung transplant, obviously donor lungs aren’t readily available. Besides, you can still put valves in an unhealthy lung without precluding transplant. In some cases, implanting valves can improve the patient’s condition and actually make transplant unnecessary. Best of all, the Zephyr Valve procedure is reversible. If the patient is having problems with the valves, they can be removed just as easily as they were implanted,” he says.
Dr. Omballi emphasizes that in utilizing the Zephyr Valve procedure, the goal is to improve patients’ quality of life so they can once again manage daily activities with fewer restrictions. He also states that he’s grateful to be part of an organization that offers such a high level of care. “UTMC always provides the most advanced, up-to-date therapies and technology, and I’m proud not only that we offer individualized, patient-centered care, but also that we treat all our patients like family, respecting all different backgrounds,” he states.
For more information about the Zephyr Valve procedure at The University of Toledo Medical Center, call Megan Waite at 419-383-3455, or email Dr. Omballi directly at mohamed.omballi@utoledo.edu.
