Zephyr Valves Opening Up Treatment Options for People With COPD

For people with chronic obstructive pulmonary disease (COPD), airflow obstruction leads to hyperinflation, causing its most troubling symptom: dyspnea of exertion, says Daniel Schwed-Lustgarten, MD, associate program director for the pulmonary critical care medicine (PCCM) fellowship program at Lehigh Valley Health Network (LVHN) and attending physician for the PCCM division, LVPG Pulmonary Medicine and Critical Care Medicine.

“In these patients, there’s just so much air trapped inside the lungs that there’s no space for more air to get back in. That leads to the main symptom of COPD, which is breathlessness,” Schwed-Lustgarten says.

Treatment options for advanced COPD have been limited to inhaler therapy, pulmonary rehabilitation, supplemental oxygen and – for a small subset of people who qualify – lung volume reduction surgery and lung transplantation. Lung volume reduction, or LVRS, performed by a thoracic surgeon in certain referral centers, involves a thoracotomy to remove 20 percent
to 30 percent of the lung, an irreversible procedure that entails a one-and-a-half to two-week hospital stay for management of possible complications.

Fortunately, a treatment approved by the FDA in 2018 that uses valves to reduce hyperinflation, called bronchoscopic lung volume reduction (BLVR), is available at LVHN. Zephyr® Valves, which are placed bronchoscopically and without an incision, now provide a noninvasive treatment option for COPD symptom relief.

“This nonsurgical option uses a series of one-way valves that we place in the most affected part of the lung, allowing air to escape out of the lung and thus reducing hyperinflation,” Schwed-Lustgarten says.

It deflates the most diseased part of the lung, and by reducing hyperinflation, allows better function of the diaphragm and intercostal muscles, and in some cases can lead to improvements in gas exchange.

Unlike LVRS, it can be used not only for individuals with heterogeneous and upper lung emphysema, but for those with lower lobe disease and even those with homogeneous emphysema.

“With the valves, we can offer the patient the same benefits achieved through LVRS, but with a procedure that is reversible and requires a much shorter hospital stay of about three to four nights and without the drawbacks common to surgery,” Schwed-Lustgarten adds.

• Diagnosis of COPD through pulmonary function test showing FEV1 between 15 percent and 45 percent predicted with evidence of hyperinflation based on a residual volume > 150 percent
• BMI < 35
• Nonsmoking for at least four months