Treating COPD With Lung Volume Reduction

An estimated 3.7% of the UAE population are believed to suffer from Chronic Obstructive Pulmonary Disease (COPD). The progressive nature of the condition which can cause debilitating breathlessness and disability, together with environmental factors – smoke, dust, fumes and sand – that can aggravate symptoms of COPD, make treatment essential.

Your doctor will be able to recommend the best course of treatment, but you may be advised to make lifestyle changes, take medication or undergo a bronchoscopic or surgical procedure, such as Lung Volume Reduction Surgery (LVRS) or bronchoscopic lung volume reduction.

What is COPD?

The first thing you need to know is that COPD is not one disease. It’s actually an umbrella term used to describe a collection of progressive lung diseases, which include emphysema, chronic bronchitis, non-reversible asthma, and some forms of bronchiectasis. Diseases that fall under COPD are characterized by increasing breathlessness, frequent dry or wet coughing, wheezing and tightness in the chest.

The people most susceptible to COPD are those who are smokers, regular inhalers of second hand smoke, or those with a prolonged exposure to lung irritants such as chemicals or air pollutants. Some patients have a genetic predisposition to the disease, for example, Alpha-1-antitrypsin deficiency (AATD).

While there is no medication you can take to cure COPD, there are several treatment options that can help alleviate the symptoms and slow down the progression of the disease. These include medications that need to be inhaled such as bronchodilators and corticosteroids, or steroid-based medications that can be taken orally. Other treatment options include oxygen therapy, pulmonary rehabilitation, bullectomy or, in extreme cases, lung transplantation.

In some serious cases of emphysema, disabling dyspnea or evidence of severe air trapping, the best option to manage the symptoms is Lung Volume Reduction(LVR).

What is LVR?

Lung Volume Reduction can be performed surgically or bronchoscopically. LVRS is a surgical procedure that removes disease-ridden lung tissue, reducing the size of an over-inflated lung, allowing for expansion of the remaining, healthy lung. Your surgeon will have to carefully evaluate you to determine the best surgical approach to treat your medical condition, but usually A minimally invasive technique called thoracoscopy, which requires three small incisions made on both sides of the chest between the ribs, is used to perform surgery on one lung. A videoscope is inserted through one of the incisions to allow the surgeon to see the lungs, and using a stapler and grasper, the most damaged areas of the lung are removed and the remaining lung is resealed.

There are now bronchoscopic (non-surgical) ways to replicate the proven benefits of LVRS in specific patients with certain patterns of disease. These include LVR using endobronchial one way valves, and endobronchial coils.

Preparing for LVR

If you are considering LVR, you should undergo extensive evaluation and preparation to minimize operative or procedural risks and optimize outcomes. Recommended steps you need to take include:

• If you are a smoker, stop smoking at least 6 months before LVR
• Once successfully screened, complete a preoperative pulmonary rehabilitation program of 6 - 10 weeks

Once all the necessary evaluations are complete, you need to have a comprehensive discussion with your family and your consulting physician about what form of LVR is the most appropriate for you. The treatment you will be offered is individualized to your specific situation, and will depend on your disease pattern, disease distribution, and degree of gas trapping and lung over-inflation on your breathing tests. Your case will be discussed at a multidisciplinary forum consisting of expert pulmonologists, interventional bronchoscopists, thoracic surgeons and radiologists and a recommendation on which LVR technique you could have (LVRS, valves or coils) made. The individual risks and benefits of each suitable treatment option will be discussed.

What you need to know about LVRS

Bronchoscopic LVR can improve the quality of life, lung function and exercise capacity for someone who suffers from COPD, and LVRS has also been proven to improve survival.. However, the results can vary from person to person. There are also certain risks involved which you should be aware of:

• Air leakage through the suture line into the lungs
• Pneumonia or infection
• Stroke
• Heart attack
• Death due to worsening of the above complications

There is also a possibility that you may not be a good candidate for any of the LVR options. This may be the case if you have:

• Severely impaired lung function
• Have exercise capacity which is too poor (for example wheelchair bound)
• Have other serious medical problems

While LVRS is not an options for all COPD sufferers, those who are considered for LVR tend to meet these criteria:

• Suffer from severe emphysema that does not respond to medical treatment
• Are younger than 75-80 years old
• Have not smoked for at least the last six months

LVR is not the go-to cure for COPD, but can make a huge difference in certain cases. Make sure you consult your doctor and undertake all the tests to see if this procedure is right for you.