The Federal Drug Administration (FDA) recently approved the use of endobronchial valves — small, minimally invasive medical devices implanted in airways — to help patients with severe forms of emphysema to breathe.
Frank Sciurba, MD, medical director of UPMC’s Pulmonary Physiology Laboratory and director of the Emphysema/COPD Research Center in the Division of Pulmonary, Allergy and Critical Care Medicine at the University of Pittsburgh, has been at the forefront of research on the devices and their effectiveness.
The endobronchial valve has been used in Europe and other parts of the world for more than a decade. Dr. Sciurba was the principal investigator on a pivotal 2010 study that led to refinements in patient selection and FDA approval in the United States in July 2018. He was lead author on a published study on the subject in the New England Journal of Medicine in 2010.
Dr. Sciurba anticipates that the FDA’s approval for endobronchial valves will be a major step forward in treating complex cases of emphysema — one of several diseases that falls under the category of chronic obstructive pulmonary disease (COPD). He expects that it will especially help patients with advanced emphysema whose daily lives are hampered by the disease.
“For many years, patients with emphysema and other forms of COPD have been treated with inhalers or, in select cases, with surgery,” Dr. Sciurba says. “The use of the endobronchial valve will be an important additional option to treat the disease.”
What Is Emphysema?
Emphysema is a chronic form of lung disease caused by smoking and exposure to other environmental toxins.
As the disease progresses, the air sacs in the lungs become permanently damaged, trapping air in the lungs and blocking the entry of fresh air. The diseased part of the lung overinflates, putting pressure on the healthy section and making it harder to breathe. Patients experience increased difficulty breathing and shortness of breath, while exercise becomes hard or impossible to do.
Patients with severe emphysema eventually have trouble performing routine tasks such as grocery shopping, bathing, and getting dressed.
According to the Centers for Disease Control and Prevention, an estimated 3.5 million adults in the U.S. have been diagnosed with emphysema, and an estimated 15 million have some form of COPD.
How Does the Endobronchial Valve Help?
Standard treatment includes medicine, such as inhaled bronchodilators, and pulmonary rehabilitation. Lung transplants and other surgical procedures are an option for only a very small number of patients with advanced lung problems. In the 1990s, UPMC pioneered lung volume reduction surgery, in which surgeons remove the diseased part of the lung to allow the healthier part to inflate.
By comparison, the endobronchial valve procedure is minimally invasive. The procedure doesn’t require any incisions or cutting. Instead, a medical team inserts tiny valves into the airway. When the patient breathes in, the valves close, stopping air from entering the damaged part of the lungs. During exhalation, the valves open, allowing trapped air out.
Endobronchial valves are designed to be permanent, but can be removed if needed. They also decrease the volume of the diseased part of the lung, according to Dr. Sciurba. “The better quality section of the lung is allowed to expand and function better. For some patients, that will really improve their quality of life,” he says.