Endoscopic lung volume reduction for COPD patients: Mayo Clinic Radio

Endoscopic lung volume reduction for COPD patients: Mayo Clinic Radio



welcome back to my old clinical radio I'm dr. Tom chives and I'm Tracy McCray according to the CDC about 16 million adults in the u.s. have COPD now that's short for chronic obstructive pulmonary disease and it means you have difficulty breathing unfortunately there is no cure and patients often end up requiring oxygen just to stay alive but there are some treatment options and one of which is called lung volume reduction not a doctor but I'm not sure that sounds good Mayo Clinic doctors are now able to perform the procedure in a minimally invasive way without a major surgical procedure joining us in studio to tell us about this technique and the results are pulmonologists that's lung specialist dr. Eric Adel of Mayo Clinic Rochester and from the Mayo Clinic in Jacksonville Florida dr. Sebastian Fernandez busi welcome both of you to the program thank you gentlemen welcome a great topic some did they wear those kind of ties in Kansas they wear these tiny kind of ties all over including Minnesota COPD chronic obstructive pulmonary disease tell us what it is dr. Dell well it's a condition primarily the result of excessive smoking exposure predominantly those that have been smoking cigarettes but we also see it in people who may have been using fires in their home to cook but in the United States predominately it's due to smoking what happens is you get injury inflammation of the airway which leads to thickening excess secretions and in many patients you actually see destruction of the lung architecture which we call emphysema so the end result as you said is difficulty breathing it's obstruction of the small Airways so people have a hard time getting air out so really the main risk factor is smoking absolutely but you see other patients who have COPD correct we do you can see patients who've had chronic inflammatory conditions like asthma who end up with irreversible obstruction that fits into more of the bronchitis or the bronchial portion of COPD rather than injury to the lung tissue which is emphysema but they're all abortion or the tubes the tubes that's right yeah and the complications why is this such a bad problem other than the fact that they have difficulty breathing I think that's it they're there lots of productivity recurrent hospitalizations because of it the the quality of life is significantly impaired as a result of their COPD lung cancer more common in these people of course yes and what about lung infections pneumonia yes they have a higher propensity for infections because they can't clear their secretions as readily and they're more inefficient is this lung volume reduction is that the only way to treat COPD or what do you what else can you do the standard management for COPD is to enhance their to reduce the inflammation of the airway so inhaled anti-inflammatories like corticosteroids and inhaled bronchodilators so people with severe emphysema there are two categories of bronchodilators that people use that effectively result in opening up the airway as best they can if the patients then are needing oxygen oxygen is actually the only medication has been shown to extend survival the rest is all about reducing hospitalizations and improving quality of life so dr. Fernandes busi tell me a little bit it doesn't sound good but explain lung volume reduction yeah so as dr. Adel was was mentioning when when you have a patient that is on full medical treatment with all the inhalers with oxygen supplementation and although none pulmonary rehabilitation and still that patient experienced severe shortness of breath and poor quality of life because of that now we had this option of endoscopic lung volume reduction we knew that actually lung volume reduction surgical lung volume reduction used to improve the breathing of these patients in a subgroup of patients with emphysema but now we have this minimally invasive option they can achieve the same results meaning lung volume reduction for these patients and in yes so tell me why if the the lungs don't work very well anyway would you want to make them smaller yes very good so as dr. adel was mentioning when you have damage of the lung architecture that part of the lung becomes ineffective its ineffective lung and becomes a bigger actually that ineffective lung is a long-long that compresses the healthier part of the lung so so not the lung is not affected of the same so there are parts of the lung that are worse and parts of Long that are better well in some patients yes so in some patients there is more damage in certain areas and actually those are the patients that benefit more from this treatment so if we are able to reduce that ineffective lung the size of that ineffective part of the lung if we are able to deflate that that will give more space for the healthier part of the lung to expand and function function and the patient will experience better breathing and of course better quality of life can you tell by looking which is the bad part and which is the good part you can you can this the cat scan or the radiograph called a computerized tomography will show the various densities within the lung can I add to what dr. Boushey just said you know I'm a very simple Kansas boy so when I think about the mechanics of the lung it's basically they fill up with air because the lung wants to collapse the smaller bronchi that breathing tubes so the diaphragms become flattened and you can actually see this on a chest x-ray either an orthopedic surgeon could see this on the chest x-ray their chest is hyper inflated and when you see see patients with emphysema they breathe with their accessory muscles so what we're trying to do is reduce the amount of gas in their thorax in their chest their diaphragm assumes more effective positioning and now the diaphragm can help them breathe so it is allowing better lung to expand but more importantly allowing a flattened diaphragm to come up and participate again in the work of breathing and the advantage of this is that you can do it through a scope as opposed to having to open the chest and remove parts alone and that's correct so so we do it under a prom cost could be a flexible bronchoscopy a bronchoscopy is a flexible tube that has a camera at the tip patient is under anesthesia we go down with this flexible tube through the mouth into the lungs and we go to the area that we already have pre-selected as the most damaged area and we placed a tiny valves and these are one-way valves that do not allow the air to get into that part of the lung when we breathe in but when we breathe out we it does allow the air to get out of that part of the lung so with time that part of ineffective lung will get deflated it will shrink allowing more space for the healthier lawn Wow fabulous and is their hospitalization required and it can be can people breathe better right away yes so they we will we like to keep the patient in the hospital for about three days and then patient can go home and usually they experiencing an improvement in their breathing over time it's not it's not right away so usually it's over the first few weeks have you been doing this long enough that you can tell us about the results and how successful this this procedure is yeah so I want to clarify something so not all patients who have emphysema are candidate for these treatments so patients who meet the requirement that we go ahead and place these valves about 80 percent of them will achieve significant benefits on their daily activities so you know it's it's a very promising treatment 80% success rate you can use an endoscopic lung volume reduction it's a new minimally invasive procedure to help patients with severe emphysema the early results obviously encouraging and it has some real advantages shorter hospital stay and fewer side effects our thanks to lung specialist dr. Sarah Jane Fernandes is the busi from the Mayo Clinic in Florida welcome to Rochester by the way and from Mayo Clinic in Rochester Minnesota dr. Eric Adele thanks gentlemen for being with us thanks for having us thank you


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