Emphysema is a type of chronic obstructive pulmonary disease (COPD) that can seriously affect your ability to breathe and your quality of life, particularly if your condition is advanced. New treatments, however, may improve how well your lungs work so you can enjoy life more fully again.
What is Advanced Emphysema?
Emphysema is a progressive lung disease, meaning it gets worse over time. If you have advanced emphysema, you may still have trouble breathing even after taking medication and completing pulmonary rehabilitation.
Doctors describe this as stage 3 (severe) and stage 4 (very severe) emphysema. In these stages of the disease, the air sacs (called alveoli) in your lungs have serious, permanent damage. Instead of allowing you to exhale fully, the damaged air sacs cause air to get trapped inside the lungs. This leads to frequent shortness of breath that can make you feel weak, so it is hard for you to do everyday activities.
Signs and Symptoms of Advanced Emphysema
Advanced emphysema causes damage to the air sacs, making it difficult to get “old” air out of your lungs. Over time, the trapped air can cause lungs to get very large and lead to shortness of breath. You may have trouble breathing when you are walking even short distances or during daily activities like showering, climbing stairs or carrying groceries. Even having a long conversation may leave you winded.
Enlarged lungs from emphysema can also put pressure on your diaphragm (which separates the abdomen from the chest), making you feel full soon after you start eating. You may also have a chronic cough or frequent respiratory infections.
Diagnosing Advanced Emphysema
When you come to the University of Chicago Medicine, your pulmonologist (lung specialist) will take a thorough history to learn more about your breathing problems and other health issues you may have. Your doctor will also ask you which medications you take and conduct a thorough examination to better understand your treatment needs and goals.
Your doctor will likely recommend tests for advanced emphysema. These include:
- Spirometry, which is a breathing test that measures the volume and speed of air moving out of your lungs
- Computed tomography, which uses advanced X-ray images to help doctors see inside your lungs (this test is also used to screen for lung cancer)
At UChicago Medicine, we have the most state-of-the-art, advanced imaging systems that allow us to see more clearly inside the lungs using less radiation than most centers.
Your doctor may also recommend other imaging tests to determine if you are a candidate for a new, non-surgical treatment for severe emphysema.
Treating Advanced Emphysema
Until recently, medical treatment options for advanced emphysema have included:
- Smoking cessation
- Medications like bronchodilators and inhaled steroids
- Pulmonary rehabilitation, a supervised exercise program for people with lung diseases
- Supplemental oxygen therapy, which helps maintain healthy oxygen levels in the body
Unfortunately, these treatments don’t relieve symptoms for everyone, especially as emphysema gets worse. For those who still have difficulty breathing, we offer procedures called bronchoscopic lung volume reduction (BLVR) and lung volume reduction surgery (LVRS) which involve excluding or removing the diseased part of the lung to help the remaining normal parts of the lung breathe better. UChicago Medicine offers consideration of lung transplantation for patients with advanced emphysema who are not candidates for any other treatment option.
Why Choose Us
At UChicago Medicine, our multidisciplinary team has the knowledge and skills to provide the most appropriate treatment for your advanced emphysema. As an academic medical center, we offer a broader range of both surgical, bronchoscopic and medical treatment options.
If you are interested in being treated for advanced emphysema, you can schedule an initial video visit with our team so we can understand your goals and suggest the best options for you.
Bronchoscopic Lung Volume Reduction
A new, non-surgical standard of care, guideline-based option at UChicago Medicine called bronchoscopic lung volume reduction (BLVR) may help ease symptoms for many patients with advanced emphysema. During this procedure, a pulmonologist places tiny valves (known as Zephyr valves and Spiration valves) in specific airways to block airflow to diseased parts of the lung. This allows the rest of lung to work more efficiently.
At UChicago Medicine, our pulmonologists are among the country’s leading authorities on BLVR. Our team has helped patients with advanced emphysema find symptom relief and avoid surgery since the valves became available in the United States. We were involved in prior research trials that helped bring these technologies to the United States and have taught doctors around the world how to perform this procedure.
Lung Volume Reduction Surgery
Our thoracic surgery team includes nationally recognized experts with extensive experience in lung volume reduction techniques. They are highly experienced in performing lung volume reduction surgery (LVRS) with excellent results. LVRS is the most effective procedure for advanced emphysema in carefully selected patients. The goal of this procedure is to remove the damaged upper part of the lung so that the more normal lower part of the lung can breathe better.
Frequently Asked Questions
In 2018, the U.S. Food and Drug Administration approved a new device, the Zephyr endobronchial valve, for people with severe emphysema. A few months later, the Spiration Valve System (SVS) was also approved. When used during a bronchoscopic lung volume reduction (BLVR), the valves can help improve lung function without surgery.
BLVR is a new, nonsurgical treatment option for severe emphysema that involves placing valves inside the airways. The valves, which are about the size of pencil erasers, block air from entering diseased parts of the lung while still allowing trapped air to be released from the lung.
BLVR is a less invasive alternative to lung volume reduction surgery (LVRS), which has greater risks and a longer recovery time. Unlike surgery, BLVR is reversible.
Before BLVR, you will receive general anesthesia. Once you are asleep, a pulmonologist will place a thin, flexible tube called a bronchoscope down your throat and windpipe into the airways. Through this tube, the pulmonologist will use special tools to place a few valves in the airways (the number varies depending on the structure of your lungs). Different sizes of valves are used based on your anatomy. The procedure usually only takes 30 minutes, and no incisions are needed.
LVRS is a surgical treatment for severe emphysema that involves removing the damaged upper part of the lung so that the normal lower part of the lung can breathe better. The damaged part of the lung is removed using specially designed reinforced staplers that are inserted into your chest using three small incisions.
Before LVRS, you will receive general anesthesia. LVRS can be performed with minimally invasive techniques. In rare cases, a larger incision through the breast bone (sternotomy incision) may be needed. With the minimally invasive thorascopic technique, the surgeon makes three small incisions (less than one-quarter of an inch in length) on the patient’s chest. The surgeon then inserts a camera and small instruments to remove the damaged upper area of the lung. The procedure usually takes about two hours.
No. Those who are most likely to benefit from BLVR or LVRS are patients with specific patterns of damage to their lungs who are unable to find relief from their symptoms through other medical treatments. That is why you need tests beforehand to determine if you would benefit from the procedure or if another option, such as surgery, would be better for you.
You are not a candidate for BLVR or LVRS if you have an active lung infection, are an active smoker or are allergic to materials used in the valve (including nickel, silicone, titanium or nitinol).
If you have advanced emphysema and we determine you are not a candidate for BLVR or LVRS, we may be able to refer you to clinical trials of other innovative devices that may help you breathe easier. UChicago Medicine is a major research institution where physician-scientists are actively studying new treatments for emphysema and other lung diseases. We may also refer you to our lung transplant team to consider lung transplantation.
The major risk of BLVR is a collapsed lung, which can cause air to leak into the chest. This is most likely to occur within the first three days after the procedure. If this happens, it can be treated in the hospital.
Other less common risks include pneumonia, coughing up blood or a worsening of emphysema symptoms.
Because of these risks, it makes sense to choose a center that performs a high volume of BLVR procedures. UChicago Medicine is one of the leading centers in the country offering BLVR. Our highly experienced pulmonologists have been performing BLVR for years and train other doctors on this procedure.
The major risk of LVRS is an air leak from the lung tissue which can cause air to leak into the chest. Air leaks usually improve as the lung heals after surgery. Our thoracic surgery team has extensive experience with managing air leaks after surgery.
After BLVR, you will typically stay in the hospital for three days so we can monitor you for potential complications, including a collapsed lung. If you have a collapsed lung, you will need to stay in the hospital for additional treatment. Then, you will complete your recovery at home.
After LVRS, you will typically stay in the hospital for three to five days so we can monitor you for potential complications. You will have drainage tubes from your chest which will help the lung heal. We will encourage you to walk, exercise and perform deep breathing exercises right away. Then, you will complete your recovery at home.
For many people with advanced emphysema, BLVR and LVRS can improve their lung function and quality of life. Besides helping them breathe easier, it can also improve their walking ability, so they can be more active in their daily lives. Some patients may feel a difference in their breathing right away, and other patients may feel a difference more gradually.
You will still need to take your emphysema medicines after BLVR. If you currently use oxygen, you may still need oxygen after the procedure.
Yes, the valves can be removed, and the procedure can be undone, if needed. Compare this to lung volume reduction surgery (LVRS), which permanently removes part of the lung.
The valves used in BLVR are designed to last more than a decade and can be adjusted or replaced.
Request an Appointment
You can also make an appointment with our providers by:
– Scheduling a virtual video visit to see a provider from the comfort of your home
– Requesting an online second opinion from our specialists
To speak to someone directly, please call 1-888-824-0200. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.
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