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Valve aids easy breathing in COPD

A umbrella-like valve may help emphysemic patients breathe more easily and could provide a noninvasive alternative to lung reduction surgery, claims a new study.

A umbrella-like valve may help emphysemic patients breathe more easily and could provide a noninvasive alternative to lung reduction surgery, claims a new study.

The findings presented at CHEST 2006, the 72nd annual assembly of the American College of Chest Physicians (ACCP), report the valve to be safe and effective for patients with emphysema.

Emphysema is a progressive and debilitating lung disorder, characterised by irreversible airflow obstruction. Current management methods include medication, supplemental oxygen, pulmonary rehabilitation, and, in rare cases, lung volume reduction surgery (LVRS) to remove the most diseased portions of the lung.

Now, the one-way intrabronchial valve (IBV) is being proposed as a nonsurgical alternative to LVRS. The device functions by limiting ventilation in diseased areas of the lungs and redirecting ventilation to the healthier portions of the lung, while allowing for normal clearance of secretions.

Dr Daniel H. Sterman, of the University of Pennsylvania Medical Center, Philadelphia, was lead author on the study. He said: “The IBV is similar in concept to LVRS in that it aims to make the lungs work more efficiently, thereby decreasing shortness of breath.

“Unlike lung reduction surgery, valve treatment has fewer complications and a shorter hospital stay.

For example, most valve-treated patients have a one-night observational hospital stay while surgical patients average a week or more in the hospital.”

In a multicenter preliminary pilot study, Dr Sterman and researchers from the Cleveland Clinic Foundation and six additional US medical centers examined the safety and effectiveness of the IBV on patients with severe upper-lobe predominant emphysema.

Over a 27-month period, 520 valves were implanted in 75 patients across the nine medical centers. The valves were implanted in the upper lobes of the lung using flexible bronchoscopy, with an average of six to seven valves implanted per patient. Researchers used quantitative software and multidetector CT scans to measure the physical effects of the valves, and the St George Respiratory Questionnaire (SGRQ) to assess how patients felt after treatment.

Of the patients who received valve treatment, 46 patients (group A) had reduced complications and retained efficacy compared with the remaining patients (group B).

In responding patients, valve treatment transferred an average of 20% ventilation and perfusion to healthier regions of the lung. Two thirds of patients in group A also had a 4-point or more SGRQ improvement at six months and showed significant improvements in oxygen use.

Compared with patients in group B, patients in group A were less than 75 years old, did not have lingular treatment, and had fewer lung segments treated. The 90-day serious complications were one bronchospasm and one COPD flare in the A group and two bronchospasm and one death with pneumothorax in group B.

“Patients responding to valve treatment may now be able to do simple, everyday activities,” said Dr Atul C. Mehta, coauthor on the study.

“Although valve treatment is still investigational, it may offer an alternative treatment for patients with emphysema who are not good candidates for LVRS.”

Valve treatment is not approved by the FDA and is only available as part of a research trial.

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