Pulmonary emphysema is a type of COPD (Chronic Obstructive Pulmonary Disease) that causes progressive and irreversible lung destruction. It is mainly caused by smoking. The intensity of emphysema is related to the number of cigarettes consumed and the number of years the person has been smoking. In Pneumology we study and try to find a solution to this type of frequent problems.
What is pulmonary emphysema?
Emphysema produces a slow and progressive deterioration of lung function. Air is trapped in the lung and cannot escape, the alveoli dilate and are destroyed, other lung areas are compressed by the dilatation and stop functioning. The lung loses its elasticity, becomes less distensible, it is like a balloon filled with air. In addition, the movement of the respiratory muscles is also limited by the distension, making breathing difficult.
In more severe degrees it leads to serious disability that prevents the patient from performing basic activities of daily living. The patient feels short of breath, even when at rest, and often requires portable oxygen to be able to leave home.
Pulmonary emphysema: types of treatment
The usefulness of treatment for pulmonary emphysema is limited. Therapeutic options include smoking cessation, respiratory physiotherapy and the use of oxygen therapy during exercise, if necessary. These are the measures that help to improve the quality of life of the patient with severe emphysema. As far as medications are concerned, bronchodilators do not produce very significant relief. In these cases, the best therapeutic option is lung transplantation, as long as a series of criteria are met and a donor is found.
Another alternative is volume reduction surgery, which is invasive, costly and with high mortality. The new challenges in the treatment of emphysema are focused on performing volume reduction by endoscopic technique, for which several techniques have been developed: sealing foam, valves and coil.
The sealing foam blocks the arrival of air to the distal diseased area, the airway collapses, the lung loses volume, decompresses and the patient breathes better. The disadvantage of this technique has been that in some patients it has produced serious side effects, so its use has not been widespread.
The valves mechanically block the bronchus allowing air to exit and not enter, which induces volume reduction. In many patients the distal bronchi in the area where the valve is placed have collateral ventilation, i.e., air arrives through an accessory pathway, and volume reduction does not occur. In these cases we have to identify which patients benefit from the valves prior to their placement.
Finally, we have coils, coils made of a memory material called Nitinol. These wires (see figure) are placed through videofibrobronchoscopy equipment. Once placed, they retract and recover their original shape, decompress the collapsed lung, repermeabilize the airway, the lung improves its distensibility, decreases hyperinflation, which reduces the patient’s asphyxia, and significantly increases his exercise capacity.
All these techniques are minimally invasive procedures performed under sedation and with a fibrobronchoscope, which allows the patient to return home within 24 hours. If the patients are well selected, their improvement in quality of life is very significant. Both lungs must be treated within 45-60 days. In these cases, 10-12 coils are usually placed per lung in the upper lobes and 12-14 in the lower lobes. Currently, there are more than 4,000 patients treated with coils in the world. The price of treatment varies depending on the number of coils or valves placed.