24 June 2015
A study at Royal Brompton Hospital has found that using airway valves to treat people with chronic obstructive pulmonary disease (COPD) can improve lung function and exercise capacity.
It is estimated that more than three million people in the UK are living with COPD, an umbrella term for a collection of lung conditions including emphysema and chronic bronchitis. The progressive disease makes it difficult for patients to breathe due to damaged airways and air sacs in the lungs.
Despite best treatment with standard medicines and pulmonary rehabilitation, many people with the condition experience increasing breathlessness and are limited in what they can do on a day-to-day basis.
The trial at Royal Brompton, called BeLieVeR-HIFi (bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures), involved placing one-way endobronchial valves into the most damaged part of the lung using a bronchoscope (a thin, flexible, fibre-optic tube).
This new minimally invasive treatment uses the valves to block off the damaged part of the lungs when the patient inhales, so the healthier areas can function more efficiently. The novel procedure provides an alternative for some patients to lung volume reduction surgery (LVRS), which is when the most damaged parts of the lungs are surgically removed.
The trial, which was funded by a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership and conducted at the NIHR Royal Brompton Respiratory Biomedical Research Unit (BRU) and Imperial College London, recruited 50 patients who had emphysema in one part of the lung and whose fissures, the separations that divide the lungs into lobes, were intact.
Half of the patients had endobronchial valves placed during a bronchoscopic procedure, whereas the other 25 patients also had a bronchoscopy but no valves were placed. Both the patients and researchers did not know who was in each group.
The results were published in the prestigious medical journal The Lancet today in a paper written by respiratory experts, including lead author Dr Nicholas Hopkinson, senior lecturer and honorary consultant physician at Royal Brompton Hospital, Dr Pallav Shah, respiratory consultant at Royal Brompton Hospital, and Professor Michael Polkey, consultant physician at Royal Brompton Hospital.
The study found that, three months after the procedure, there was less trapped air in the lungs of the patients treated with endobronchial valves and a median improvement of 8.8 per cent in the amount of air that they could breathe out in one second.
Additionally, treatment with the endobronchial valves was associated with significant improvements in exercise capacity. For example, the patients who received the valves were able to cycle on average 139 seconds longer than they could before, compared with a small decline in the control group.
Other improvements were found in breathlessness during exercise, lung volume and gas transfer, which measures how efficiently the lungs can exchange carbon dioxide for oxygen.
Commenting on the research, Dr Hopkinson said: “The results are very exciting because they show, for the first time in a rigorous randomised controlled trial, that endobronchial valves can improve lung function and exercise capacity and achieve similar results to those seen with LVRS in properly selected patients.
“The improvement in gas transfer is of particular significance because this measure of lung function is the one most strongly associated with survival rates for COPD patients.
“A further study involving a larger number of patients is now needed to establish the best use for this technique in relation to other COPD treatments, such as LVRS and other novel treatments like lung volume reduction coils.”
The full paper can be read on The Lancet's website