Jay Nash of Pulmonx with Annette Eiben and Dr Samuel Kemp
A hospital employee has become the latest emphysema sufferer to undergo a new procedure that is offering a lifeline to people with serious respiratory conditions. Former King’s Mill Hospital worker, Annette Eiben from Mansfield, is the latest person to receive endobronchial lung volume reduction (ELVR) treatment using the Pulmonx Zephyr Endobronchial Valve.
The procedure was carried out by Dr Samuel Kemp, a consultant physician at the Mansfield hospital, and Eiben has described the difference to her quality of life as ‘nothing short of amazing’.
The 58 year old has been living with emphysema for several years and prior to having her procedure the simplest of tasks such as drying herself after a bath or reaching for a plug would leave her breathless, not to mention the daily struggle of walking up and down stairs.
Since the operation I have not had one attack and the feelings of independence and confidence I now have really are life changing. She told BBH: “When Dr Kemp suggested the valves I said ‘yes’ immediately. After all, I had nothing to lose and everything to gain.”
Dr Kemp said Eiben was already receiving the maximum level of therapy possible combined with ongoing rehabilitation and was on the waiting list for a transplant.
He added: “Transplant is the definitive treatment for COPD, but it is not appropriate for everyone and also carries a high level of risk. Annette was very keen to try something less invasive so, with this in mind, I felt she would benefit greatly from the EBV valves.”
The endoscopic procedure typically takes less than an hour to complete and because it is non-invasive patients do not require a long recovery period, though an overnight stay in hospital is sometimes required.
Once the Zephyr Endobronchial Valves are in place they prevent air from entering the most damaged areas of lung when breathing in, while allowing air out when a person exhales. This causes airflow to be directed towards the better functioning lung, together with deflation of the most damaged parts, leading to a reduction in the volume of trapped gas and improving breathing mechanics.
Since Eiben had the procedure, her lung function and ability to breathe have improved, leading to a better quality of life and increased independence and confidence so she can enjoy leisure activities and is able to carry out daily routines without the fear of needing oxygen.
I would certainly recommend considering endobronchial valves treatment to other physicians looking for an effective means of treating COPD patients
Dr Kemp is leading research in this area and told BBH:
“EBVs are a truly exciting new technology that enables us to make a real difference to the lives of patients with emphysema by reducing breathlessness and improving quality of life.
EBVs allow us to change the structure of the lung and lung function tests have shown that in Annette’s case a massive improvement in respiratory function has been achieved. Immediately after the operation she could feel a marked improvement in her breathing and this positive result has continued in the intervening weeks to the point where her most recent tests have shown a loss of 1.3 litres of trapped gas”
“These latest figures prove beyond doubt just how successful the operation has been as this huge reduction allows healthy lungs to inflate properly. I would certainly recommend considering endobronchial valves treatment to other physicians looking for an effective means of treating COPD patients.”
Eiben added: “The feeling of being unable to take a breath can be extremely scary and I was having more and more panic attacks, both when at home and out and about. Even the smallest hill or flight of stairs would cause me distress. However, since the operation I have not had one attack and the feelings of independence and confidence I now have really are life changing.”
Since it was introduced, Pulmonx has been used on more than 4,000 COPD patients around the world. See the following video for more details –
Me and my operation: The tiny bell that breathes life back into your lungs
Every year 900,000 Britons are diagnosed with lung conditions such as emphysema and chronic bronchitis which leave them breathless. Susan Matthews, 62, a retired administrator from Wiltshire, underwent a new, non-invasive treatment.
A bell-shaped valve has transformed the life of one emphysema sufferer. Twelve years ago, I started feeling breathless when I was walking uphill or for long distances. At the time I assumed I was just out of shape: as an administrator my day was fairly sedentary. I’d also, ashamed as I am to admit it, smoked on and off for the previous 20 years — up to 20 cigarettes a day. The breathlessness got worse, and five years after the symptoms started I went to see my GP. By this stage I was gasping for breath. I was referred to a consultant who diagnosed emphysema, where the lungs become inflamed — when I breathed in, the air was getting trapped and wasn’t being exhaled. Over time the air builds up, taking up more and more space in your lungs so you can’t take as much air in — that’s why I’d been feeling so breathless.
Although both lungs were affected, the left was more damaged. The consultant said unless it was treated it would just get worse and could even be fatal as the lung tissue is gradually destroyed.
I was horrified, though in my heart I knew this was because I’d been stupid enough to be a smoker. Of course, I stopped completely straight away. The consultant said the only treatment was to operate to deflate the damaged lung permanently, but because my breathing was so bad I just wasn’t well enough for surgery. My breathlessness was getting steadily worse and it got to the stage when it was impossible to walk to the shops or even upstairs. I also started to get chest infections every few months. I barely wanted to go out because everything was such an effort and I was so reliant on my husband, Brian, and our daughter Rhiannon, 31.
Then, last autumn, I was told about a new non-invasive procedure. The surgeon would put a tiny, bell-shaped valve down my throat and into the damaged part of my lung so the trapped air could be released, making it easier for me to breathe in and out. The valve works one way so that when you breathe in it doesn’t allow air to the damaged part of the lung, yet it allows air out when you exhale. I was terrified at first. But my consultant, Ms Kornaszewska, reassured me there was very little risk of complication since I wasn’t having a general anaesthetic or open surgery.
Anyway, by now I had so much trouble breathing that I could barely talk or get out of a chair without gasping. I couldn’t face going on the way I was.
I had the two-hour operation under sedation at Heath Hospital in Cardiff in October 2011, and was kept in for five days. I had a sore throat when I woke up, but, remarkably, I wasn’t out of breath any more.
Since then, life has changed for the better. I enjoy walking again, going to the theatre and playing with my nine-year-old grandson, Cameron. They’re just normal things, but it’s so easy to take them for granted.
Margaret Kornaszewska is a cardiothoracic surgeon at University Hospital, Wales. Chronic obstructive pulmonary disorder (COPD) — the umbrella term for lung conditions such as emphysema is a very widespread problem. In fact, recent research suggests it may be hugely under-diagnosed as many as one in ten people over 40 in Britain may have a form of COPD. More people die each year from these lung conditions than from breast and prostate cancer together. The condition is linked to smoking, exposure to cigarette smoke and jobs such as mining or the chemical industry, but it can also be caused by earlier serious chest infections.
Operating to reduce this over-inflated area of the lung is thought to be the best way to resolve the problem. However, this is quite risky since emphysema patients are already unwell. It also means a long hospital stay and, as with all operations, carries the risk of infection. Endobronchial lung volume reduction can achieve the same results, but with a minimal risk of complications as there’s no open surgery involved. It involves placing a one-way, bell-shaped valve (about 10mm long and 5mm wide) in the bronchi, the tubes that run into the alveoli, in the most over-inflated part of the lungs. When the patient breathes in, the valve closes and prevents air being directed to the damaged part of the lung, so preventing further inflation. However, when the patient breathes out, trapped air is able to flow through the valve and out of the lung. This improves the patient’s ability to breathe, and of course it allows them to be more active, which improves their overall wellbeing. Depending on a patient’s condition, the number of valves used can vary from one to 15. The procedure was trialled at the Royal Brompton Hospital, West London, around two years ago, and is available in a limited number of NHS hospitals, but there are plans to make it more widely available.
With the patient under sedation, I place a special camera on a tube (a video bronchoscope) down the mouth and directly into the damaged area. This transmits images of the lung onto a computer screen so that I can see exactly where to place the valve. The valve, which is made of mesh, is then compressed into a catheter (a thin tube) and put down the throat. Once guided to its exact location, the valve is pushed out of the catheter where it expands to its full width. The valve creates an airtight seal against the wall of the bronchi to prevent air from leaking around the device. The valve stays in place because of internal pressure in the body, so then we simply withdraw the catheter and camera back through the mouth.
As there’s no invasive surgery there is no risk of infection, no need for painkillers and the effects are almost immediate.
The procedure costs £10,000 to £15,000 privately, depending on the number of valves used, with a similar cost to the NHS
In the UK, the LIBERATE clinical study will be recruiting patients at Royal Brompton Hospital, Bristol Royal Infirmary and Liverpool Heart and Chest Hospital.
You can contact – Dr Sam Kemp through his email firstname.lastname@example.org