Lung valves allow some emphysema patients in Nebraska to do more

137 million people are living in areas containing unhealthy levels of air pollution, according to the American Lung Association's new "State of the Air" report card.

Over the last few years, Susan Steffel had noticed that she got winded more easily.

"Just a flight of stairs, I’d have to catch my breath after," said Steffel, 68, who lives in a two-story house in Beaver Lake.

Steffel

In April, Steffel, who has emphysema, had three tiny, one-way valves placed in the airways of the left lower lobe of her lung. The use of the procedure is part of a relatively new program at Creighton University Medical Center-Bergan Mercy.

A duckbill valve like those in a whoopie cushion, a Zephyr valve is designed to let air out of — but not back in — less functional parts of the lungs, which become hyperinflated over time in people with emphysema. The hyperinflated areas take up more than their share of space in the chest, crowding the functional parts of the lung and hampering their ability to expand and contract normally with breathing.

"What we’re really doing is reducing the size of the less functional part of the lung to let the more functional part have more room to expand and contract," said Dr. Zachary DePew, division chief of pulmonary, critical care and sleep medicine with CHI Health.

DePew

A few weeks later, Steffel noticed an improvement in her breathing. At the doctor's office, she could walk farther in a timed test, a measure of functional capacity.

"I can climb stairs and I don't have a problem," she said.

And, if she does something that causes shortness of breath, it doesn't take her as long to recover.

DePew said the procedure is not a cure but a treatment aimed at reducing shortness of breath in patients with emphysema, improving their quality of life and their ability to be active.

Nearly 15.7 million Americans, about 6.4% of the population, are affected by COPD, according to the Centers for Disease Control and Prevention. More than 3 million have emphysema. The main cause of both is smoking, according to the American Lung Association. Steffel said she smoked in her teens but quit long ago.

Traditionally, COPD is managed with inhalers, oral medications and oxygen. Steffel had been on a triple therapy, standard for people with COPD, that involved two long-acting bronchodilators and an inhaled steroid.

At her last visit, DePew, an interventional pulmonologist, took her off the steroid. While they’re helpful, he said, they come with their own potential risks.

CHI Health officials had planned to start the program last fall, DePew said, but it got delayed by the pandemic. Since starting in March, the team has completed valve placement in 11 patients.

Zephyr valves such as these reduce the size of less functional parts of the lung to give the more functional parts more room.

Nebraska Medicine's efforts in the area likewise were delayed by the pandemic, but that health system also has started a valve clinic, said Dr. Brian Boer, Nebraska Medicine's section chief of critical care medicine. He said he thinks doctors there have placed one valve so far, although they have placed a different type of valve in several patients with collapsed lungs.

"I think it's a great option for the right patient," he said, "and that's why we want to find those people."

DePew said not every patient with emphysema will be a candidate for the procedure. Only about one in four patients referred for the procedure actually gets the valves. Patients must meet a number of criteria, including not having too large a pocket of trapped air.

At CHI Health, screening starts with program coordinator Jillianne Danahay, a nurse practitioner.

Pilli

Dr. Suchitra Pilli, an interventional pulmonologist with CHI Health, said the team has the capacity to perform four procedures a month.

The valves are placed by threading them through the nose or mouth and into the airways using a flexible tube with a camera called a bronchoscope.

While the procedure is considered minimally invasive, DePew said patients spend a minimum of three nights in the hospital for observation to make sure they don't suffer a collapsed lung, which is the main potential side effect.

Boer noted that the risk of lung injury returns to baseline after three days.

Pilli said the CHI Health team can respond to any problems that occur while patients are hospitalized within 15 minutes. Patients have follow-up appointments at one week, 30 days, 45 days, six months and a year.

The valve was approved by the Food and Drug Administration about five years ago. It has been in use longer in Europe.

While it's too early to say how long the benefits will last, DePew said, data published in Europe indicates patients still were benefiting five years later.

"That's about as good as you’re going to get, because it just hasn't been around very long," he said.

Pilli said the team has been holding educational sessions for other physicians about the procedure, which is covered by Medicare and insurance.

Physicians also can do surgery to reduce the volume of the lung, she said. But patients have to be able to tolerate general anesthesia and spend at least a week in the hospital afterward.

DePew said the surgery still is an option for the right patient. The valve procedure isn't a replacement for it. But the selection criteria are even more stringent, and fewer centers offer it, meaning patients have to travel farther to get it.

Steffel, a mother of five and grandmother of 10, said she knows her lung function never will return to normal. But she said it's a relief to be able to be more physically active. She and her husband, Ray, recently hosted four of their young grandchildren for a weekend. She said she hopes others will explore the procedure.

"I appreciate what he's done for me," she said of DePew, "so I’m hoping more people will."

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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