Inclusion:
- Ex-smokers (≥4 months)
- PFT:
- Post BD FEV1 15 – 45%
- TLC ≥100%
- RV ≥150%
- 6MWD
- ≥ 100 – <500 meters after pulmonary rehabilitation program
- BMI <35 Kg/m2
- Completed pulmonary rehabilitation program (or is enrolled and completed 6-8 sessions)
- ABG: PaCO2 <60
- Stable on prednisone <20mg/day
Exclusion:
- Any contraindication to bronchoscopy and/or general anesthesia
- Lung findings:
- Pulmonary nodule requiring work up
- Giant bullae (>1/3 hemithorax). May be referred for bullectomy
- Comorbidities:
-
- Recent CV event (6 months)
- Recent CVA (3 months)
- Known uncontrolled PAH sPAP >60
-
- Prior lobectomy, LVRS, lung transplant, median sternotomy, recurrent pneumothorax
Careful consideration in:
- FEV 1 < 15%
- CHF w/EF <45%
- DLCO <20%
- Baseline 6MWD <100m
- Lack of access to medical care
Tests required (may be ordered by the referring physicians or us):
- Complete PFT within 1-year
- 6WMD within 1-yr
- ABG
- TTE
- completion of a pulmonary rehab program
powerpoint presentation outlining BLVR
Literature supporting BLVR
BLVR heterogenous emphysema and intact interlobar fissures {BELIVER HIFI] (Davey, Lancet, 2015)
Zephyr Endobronchial valves heterogenous emphysema (Criner, AJRCCM, 2018)
Meta-analysis LVRS, BLVR (van Geffen, Lancet Respir Med, 2019)
RCC Spiration Valves [EMPROVE] (Criner, AJRCCM, 2019)
Patients will have a bronchoscopy under general anesthesia in the operating room where a predefined lobe will be occluded using endobronchial valves (Zephyr). Post-procedure the patients:
1. Three days in F2
2. Morning daily CXR and CXR as needed for respiratory symptoms
4. If PTX is confirmed start your usual management and notify IP immediately
Patients need daily CXR and evidently CXR as-needed for respiratory symptoms. There will be an “PNEUMOTHORAX ALERT” over their beds and a PNEUMOTHORAX CART in their rooms. This cart has all the supplies needed for acute decompression and chest tube insertion (pigtail and surgical).
In the event of respiratory symptoms please order a CXR STAT. If PTX is confirmed then start the steps you would normally carry out for pneumothorax and immediately notify the IP fellow and/or staff on call and we will guide you regarding next steps.
CONVERT II TRIAL
Here is information on the CONVERT II Trial which is a trial to evaluate the safety and effectiveness of AeriSeal® System to block collateral ventilation (CV) and convert a severe emphysema patient from CV+ to CV- status.
Here is an information document regarding an adverse effect known as Post-Airway Inflammatory Syndrome (PAIR) in patients who have undergone the AeriSeal® procedure