Creighton physicians explore new frontier in treating emphysema, COPD
A team of Creighton University and CHI Health physicians are the first in the state of Nebraska to offer new hope to people suffering breathing difficulties related to severe emphysema or chronic obstructive pulmonary disease.
A new procedure involving inserting tiny valves into the airways of diseased lungs enables the healthy portions to expand, thereby lifting pressure on the diaphragm and making breathing easier. Dubbed “Zephyr Endobronchial Valve Treatment” after the implanted “Zephyr” valves, the procedure was approved in Europe before gaining FDA sanction.
In 2019, Zachary Depew, MD’07, division chief for pulmonary and critical care at CHI Health Creighton University Medical Center-Bergan Mercy and associate professor of medicine at the School of Medicine, began the process of bringing the procedure to CHI Health and therefore to Nebraska.
“But that takes time,” Depew says. “It’s a new device, and you have to go through the bureaucracy of medicine and then, unfortunately, just about the time we were making headway, COVID hit, and that stymied us for a while.”
With those hurdles cleared, Depew and his team, which includes Suchitra Pilli, MD, pulmonologist and assistant professor at the School of Medicine, inserted their first Zephyr valves in March. Another seven patients have been treated since, for a total of eight implantations.
The noninvasive procedure uses a thin, camera-equipped tube known as a bronchoscope to insert the valves. The bronchoscope, which is inserted into the lungs through the mouth while the patient is sedated, compares well, Depew says, with established procedures that involve surgical removal of diseased portions of the lung.
“In most classic smoking-related emphysema the predominance of disease is in the upper lobes because smoke rises,” he says. “So surgeons went into the chest and surgically removed the upper parts of the lungs — in essence removing the most diseased parts, which then reduces the total volume in the chest and allows the healthier, lower lobes more room to work.”
While the procedure worked well for patients who met strict inclusion criteria, its complexity restricted it to a few large medical institutions around the nation, Depew says, which in turn raised problems of access in addition to risks of mortality and post-surgery complications.
So, medical device companies began to ponder whether similar benefits could be obtained without the trauma of surgery. Consequently, there appeared on the market various devices that never really won acceptance until the advent of the Zephyr valves, which, Depew says, seemed the safest and most effective of the new options.
As with the surgical approach, candidates for Zephyr valve implantation must meet certain criteria, although those criteria are not as rigorous. They must have significant emphysema, an “air trapping” condition in which inhaled oxygen cannot escape the lungs and a functional impairment stemming from that air trapping. Their conditions, however, while they must be significant, cannot be so severe as to place them at high risk.
Depew says Creighton University and CHI Health are the first medical institutions to offer the procedure in Nebraska and, as far as he is aware, the only one. The closest alternative locations, he says, are in Kansas City, Missouri, and Rochester, Minnesota.
With eight procedures completed, and with outcomes ranging from transformed lives to others who gained little benefit, Depew says his team is learning fast.
That Creighton-trained pulmonologists are being introduced to this new procedure is good for Creighton and good for the nation, Depew says.
“One of the best things that we can do for people around the country is to train pulmonologists who learn how to take good care of patients through procedures like this,” he says. “We send a lot of our trainees into the wider world, which means we can help provide more access to novel and effective care from Creighton-trained physicians.”