New Treatments for COPD
I can’t tell you how many times a person with emphysema/COPD has come up to me, really frustrated, and said, “There must be something they can do to help me breathe better. Can’t they just go in there and do something to open up my lungs?” Or, “Can’t they do something to get rid of all that extra air? It seems like they can do everything else nowadays. Why can’t they do something for people with COPD?”
These are excellent questions, for sure, and until recently there really were not a whole lot of somethings they could do beyond major surgery. But, thanks to years of research and some new developments there is hope for those with COPD without extensive and risky surgery.
Do Your Part
Before we explore these options, you must know that these procedures are not replacements for (but partners with) good medication compliance, regular exercise, and basic healthy living - which, of course, means no smoking In other words, you can’t just have a procedure done, go home and sit on the couch and expect to be all healthy. As a lung patient you always have to do your part to take your medications as prescribed, exercise effectively, communicate honestly with your doc, and keep a positive attitude to help yourself breathe as well as possible.
What’s Really Wrong with My Lungs?
To understand these procedures, it’s important to know just what you, the person with Emphysema / COPD is up against. The basic cause of shortness of breath in folks with COPD/Emphysema is hyperinflation. In the emphysema component of COPD, the lungs actually get bigger. They are over-inflated and stretched out and have lost a lot of their elastic recoil (the ability to spring back when expelling air). The lungs become crowded inside the chest - making you feel like you’re breathing against an inflated airbag in your car. In chronic bronchitis (the other part of COPD), the walls of the airways become weak and more likely to collapse. Because these problems involve the destruction of extremely delicate lung tissue, they cannot be fixed by being repaired or replaced as surgeons do with a clogged blood vessel or a broken bone.
It’s hard sometimes to picture what’s going on inside the lungs. But, there are some really good videos that make sense out of some pretty technical procedures.
You’ve probably heard about stents for the vessels of the heart and the legs. Now there’s a stent that props the airways open in the lungs so trapped air can be more easily expelled.
The valve is an umbrella-like device that directs the air away from diseased areas and into healthier sections of the lungs.
Another kind of stent works to open a new air passage by connecting a severely diseased airway with a less-diseased airway, kind of like making a detour in the road. It gets you there, but you’re just taking a different path.
Each of these three above procedures is done via bronchoscopy.
While we’re at it, let’s review three other procedures that have been around for a while.
Successful lung transplant is done in select hospitals, but it is very difficult to find good lungs for donation. If a person undergoes transplant he or she usually receives only one new lung in order for another person to receive the other donated lung. Doctors are currently saying that expected survival time after lung transplant is five years if the recipient survives the first year. Of course this varies widely, and people have been known to survive a lot longer than that with one or two “new” lungs.
One procedure that has met with success for a small population of patients meeting strict criteria is lung volume reduction surgery (LVRS). This is when the top third of the lungs are removed to allow more room for expansion. This is major surgery that involves putting a patient under general anesthesia, opening up the chest, and operating on the lungs.
Blebectomy, or bullectomy, involves removing a portion of lung that is non-functional. You can think of a bleb as a big bubble or blister, that when large, may prevent the remaining lung from working efficiently. The main reason to do this procedure is to remove small blebs that are causing lung collapse (pneumothorax). Bullectomy is done once in a while on patients with emphysema who have very large bullae, taking up more than one-third of the volume of the chest on one side. The procedure should be done by a chest surgeon familiar with lung surgery that is done using a tiny camera and small incisions. This procedure is not often indicated for people with emphysema.
Learn what you can about each of these procedures and ask your doctor about them at your next appointment. In order for these treatments to be safe and appropriate, of course not everybody is a candidate, but you never know until you ask!
Respiratory Therapist, COPD educator and author