Bronchoscopic Lung Volume Reduction (BLVR), a new treatment at Penn Pulmonary Medicine, is offering hope for patients with advanced for COPD/emphysema who are not candidates for lung volume reduction surgery or lung transplantation.
Coronal view of the right lung prior to therapy (A) and significant reduction of the right upper lobe volume (upper arrow), complete deflation of the right middle lobe, and return of the diaphragm to a more natural configuration (lower arrow) following BLVR (B).
The progress of emphysema and chronic obstructive pulmonary disease (COPD) is unremitting and prolonged. Outside of occasional exacerbations, patients with COPD and emphysema experience a consistent decrease in their quality of life (QOL) as their condition worsens in its severity.
Deterioration in QOL and health status is so insidious that patients often accept their symptoms and limitations as normal. Worse, with time and the continuing destruction of lung tissue, many feel that the disease can't be treated or reversed.
Lung Valves for COPD: Bronchoscopic Lung Volume Reduction
Of course, much can be done to address the symptoms and effects of COPD/emphysema, according to Kevin Ma, MD.
Dr. Ma is the Clinical Director of the Bronchoscopic Lung Volume Reduction Program at Penn Medicine, where much of the pioneering work in therapy for the diseases began with the work of Joel Cooper, MD, an Emeritus Professor of Surgery at Penn.
Using implantable endobronchial valves, Penn offers a non-surgical treatment for patients with advanced COPD/Emphysema: Bronchoscopic Lung Volume Reduction (BLVR).
What is Bronchoscopic Lung Volume Reduction?
Bronchoscopic Lung Volume Reduction involves implantable endobronchial, one-way valves to prevent re-inflation once air has escaped a targeted lobe. In a fully occluded lobe, this will cause deflation, leading to a reduction in air trapping and hyperinflation allowing the better parts of the lung to re-inflate and for the diaphragm to achieve a more comfortable position.
BLVR offers hope to patients who are not candidates for lung surgery, with fewer risks and less restrictive inclusion criteria than lung volume reduction surgery (LVRS).
In addition to its nonsurgical status, BLVR has fewer risks and generally less restrictive inclusion criteria versus LVRS and lung transplantation. Moreover, endobronchial valves have been shown, at =12 months following treatment to improve dyspnea, exercise tolerance and quality of life in selected persons with advanced COPD.
"We've had patients preparing for a lung transplant elect to come off the waitlist after BLVR because of how good they're feeling," Dr. Ma explains.
Criteria for Lung Valves: Who Is A Candidate?
"The best patients for BLVR are those with a diagnosis of COPD whose pulmonary function test shows severe hyperinflation and air trapping," says Dr. Ma. "These patients should really come and see us if they're still having symptoms from their COPD."
Patients cannot have had prior LVRS on the target lobe, significant resting hypoxemia, or pulmonary hypertension, and must be non-smoking, among other qualifications for endobronchial valve implantation.
Patient Criteria for Endobronchial Valve Implantation
Candidates for BLVR:
- Have a diagnosis of COPD with pulmonary function tests showing severe hyperinflation and air trapping;
- Have a BMI ≤ 35;
- Meet Pulmonary Function Test Cutoffs: FEV1: >15%, <45%; TLC: >100%; RV: >150% (>200% if homogenous disease on imaging evaluation); DLCO >20%
To screen for eligibility, the patient must have recent full PFTs, a 6MWD and a high-resolution, non-contrast CT scan (1mm) — ideally completed within the last six months. (Additional testing can be completed locally after we speak to the patient about the procedure.)
View the patient criteria sheet
Unsure if your patient meets this criteria? If you are unsure if your patient meets this criteria, Penn Pulmonology can conduct the preliminary screening (and can evaluate patients with emphysema).
Additionally: Since BLVR candidates must be non-smoking, Penn Medicine offers a comprehensive smoking cessation program for all patients. For more information on the smoking cessation program, call 888-736-6786.
Common Questions About BLVR
Dr. Ma hears these common questions about Bronchoscopic Lung Volume Reduction from both patients and providers:
What has been the experience for most patients to date with this treatment?
Our patient experience parallels what's seen in the clinical trials — that "patients with more air trapping and more heterogenous disease tend to have the best results," Dr. Ma explains. "The results in patients with homogenous disease are typically more modest."
Penn Lung Center specialists carefully consider the degree of hyperinflation/air trapping, the degree of heterogeneity of lung destruction, and fissure completeness to predict who may experience a substantial benefit.
Do the valves ever need to be adjusted?
"There is a possibility that valves would need to be readjusted — either because they migrate, shift or malfunction, Dr. Ma says. (The likelihood of valve adjustment in the post-market data is currently about 10-15% over 2 years.)
Do the valves stay in if the patient is feeling better, or can they be removed?
Dr. Ma notes that the valves are designed to remain in place indefinitely. "Removing them would reverse their beneficial effects," explains Dr. Ma. "However, if patients do not benefit from them, or if problems arise, the valves can be removed without permanent impact."
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