Many of us take the ability to breathe easily for granted. But that’s not the case for people who have emphysema. This lung condition — a type of chronic obstructive pulmonary disease (COPD) — causes shortness of breath and gets worse over time, which can severely limit everyday activities.
Treatment options for emphysema typically include medications, oxygen therapy, and lifestyle changes. But at Temple, select patients with severe emphysema may be eligible for a minimally invasive treatment called bronchoscopic lung volume reduction (BLVR). BLVR can help people with severe emphysema breathe better, and enjoy a higher quality of life.
As Temple’s BLVR program coordinator, I field a lot of questions about the procedure. Here are some of the key questions I'm often asked.
What is BLVR, and how is it performed?
To understand how BLVR works, it helps to understand the basics of emphysema.
With emphysema, the lungs are often hyperinflated meaning the airways inside the lungs trap a lot of air. When you can’t breathe air out of the lungs, it is hard to get air into them. This makes it difficult to breathe.
BLVR is a minimally invasive procedure — it is done without any incisions. Doctors guide a bronchoscope (a flexible tube with an attached camera) through the mouth or nose and insert tiny endobronchial valves into the part of the lung that is hyperinflated. These one-way valves block off diseased parts of the lung, allowing the healthier parts of the lung to expand so that there is more room to breathe in that much needed air.
Who is eligible for BLVR?
BLVR is reserved for people who have late-stage emphysema. Here’s why: When patients are in the earlier stages of COPD, these endobronchial valves won’t make that big of a difference. Their lungs are not in bad enough shape for this procedure to give them any substantial benefit. In other words, they will not benefit from BLVR as much as patients in later stages of the disease do.
To benefit from BLVR, you must have severe emphysema and a high volume of air that is being trapped in your lungs based on lung function tests that we do. Ideal candidates for BLVR also have not had previous major lung surgeries, do not currently have major heart problems — such as uncontrolled atrial fibrillation — and have not smoked for at least four months.
How do patients qualify for BLVR?
We try to select the patients who will have the maximum benefit from this therapy, and that is why we need to do extensive tests. Testing to determine if you are eligible for BLVR is generally done in three parts, over about 21 days.
I usually tell patients to prepare for a six-hour day for the following first round of tests:
- Pulmonary function test, which measures how well the lungs work.
- Six-minute walk test to measure exercise tolerance.
- Arterial blood gases test, which measures oxygen and carbon dioxide levels in the blood.
- Cardiopulmonary exercise test, which will tell us how much air is trapped in the lungs when patients exert themselves.
- High-resolution CT scan to see inside the lungs.
A week after having these tests, patients come back to Temple for an echocardiogram and a cardiac stress test. Both tests are done to check that there aren’t any major uncontrolled heart issues, which could make someone ineligible for BLVR.
A week after that is the last day of tests, a lung profusion scan to check blood flow in the lungs. On that day, patients will also see Gerard Criner, MD, FACP, FACCP, the director of the Temple Lung Center, in the clinic. He will review all these tests and then let them know if they qualify for BLVR.
Does BLVR require anesthesia and a hospital stay?
Yes. BLVR is an inpatient procedure. It’s done under general anesthesia, and it takes about one hour. Afterward, patients typically stay in the hospital for a minimum of four nights.
How long is the recovery?
I tell patients that they usually will come back to see Dr. Criner about a week after they have BLVR for a six-minute walk test and a chest x-ray. And if the results of those tests are good, they can resume normal daily activities after that. We usually tell them to wait about three weeks before exercising.
Are there possible complications?
The main complication after BLVR is pneumothorax, commonly called a collapsed lung. This is the reason why we keep patients in the hospital for at least four nights. We watch for this complication, and if a collapsed lung occurs, we treat it with a chest tube and suction.
Will BLVR cure my emphysema?
BLVR is not a cure for emphysema. After BLVR, you still need to take your emphysema medications. But BLVR can make your quality of life better.
For instance, BLVR can improve your:
Breathing. Every patient is different. Some patients might require less oxygen therapy than they did before the procedure, and some patients don’t require any oxygen after BLVR.
Ability to exercise. Most patients are able to walk more, and are less tired. For instance, when we do the six-minute walking test after a successful BLVR procedure, patients can walk about 165 feet farther — and sometimes even a little more — than they did before. It all depends on the patient and how well the procedure worked for them.
Ability to do more day-to-day activities. Patients may find it easier to carry on a conversation with other people because they are not short of breath. And they are able to take deeper breaths than before. Patients may find it easier to walk up and down stairs in their homes and do things like play with their grandkids.
Lung function. After about six weeks, with testing, we are able to tell our patients the exact difference BLVR has made in their lung function.
If I’m not a candidate for BLVR, what are some other treatment options?
If you are not a candidate for BLVR and you have severe COPD, you may be eligible for other therapies. For example, at Temple, we are a certified center for lung volume reduction surgery (LVRS) and lung transplant. And we are the No. 1 center in the nation for lung transplant volume, meaning we perform the most lung transplants.
If a patient is not a candidate for those other surgeries, we may offer a clinical trial. We have ongoing clinical trials for people with COPD.
Medical management is another option we can offer patients who don’t qualify for BLVR because they don’t have severe emphysema. Often, we can give these patients some extra medication to help with managing their COPD.
Temple leads the way in BLVR
Our physicians have a lot of experience with BLVR — in fact, we were the first center in the nation to perform this procedure. Because of our expertise, doctors from around the country come to Temple to learn how to perform BLVR.
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