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New Procedure For Severe Emphysema: Endobronchial Valve System?

I first learned about this in 2015. The product is called the Endobronchial Valve System (EVS). It was supposed to improve the qualify of life for those living with severe emphysema.

Back then it was in the study phase. It seemed to show promise early on. Then I forgot about it until I opened up my email today. It seems as though the study phase is complete. And the product has been approved by the FDA. So what is this new product? How might it help people with emphysema? Here’s what to know.

Let’s begin with a little anatomy

Before I define what an EVS is, we must first have a good understanding of emphysema. If you want you can review my article, “What Is Emphysema?” Or, I will offer a quick review here. If you know all this, you can skip to the second section.

Your lungs consist of many airways. These airways lead to clusters of small, balloon-like structures called alveoli. Alveolar walls are made of elastic tissue. Like balloons, they expand when you inhale. Then they recoil to their natural shape when you exhale.

Emphysema is when alveolar walls become inflamed. This causes alveolar walls to become stiff over time. When you inhale they still expand. But, when you exhale they fail to close all the way. This causes air to become trapped inside of them. These bad areas of your lungs are said to be hyper-inflated. These hyperinflated areas take up space, and sometimes lots of space.

You also have good areas of your lungs. These areas are well ventilated. But, due to all the extra air in bad areas of your lungs, good alveoli have less room to expand. The combination of these effects causes a feeling of dyspnea (shortness of breath).

How do Endobronchial Valves help?

So, let’s say you have emphysema. Your doctor will first treat you by other means. Many people with emphysema respond well to medicine or other treatment. But, as the disease advances, emphysema may become poorly responsive to this treatment. It becomes severe. So, it’s these patients who may benefit from this procedure.

Other options for severe emphysema are lung volume reduction surgery and lung transplant. But, these procedures are invasive. They come with some significant risk. There’s also another new procedure using “Lung Coils.” That procedure I will describe in an upcoming post. But, the option we are talking about here is the Endobronchial Valve System.

What they are are one-way valves. They are put inside airways leading to these poorly ventilated areas of your lungs. They do not allow air you inhale to get past the valves. Air does not enter into these poorly ventilated areas. But, when you exhale trapped air in these areas can get out through the valve. Since this air is getting out, it sort of deflates these bad areas. This creates more room for well-ventilated alveoli to expand.1

At the same time, air is diverted past the one-way valves to good areas of your lungs. In other words, oxygen-rich air bypasses poorly ventilated airways and travels to well-ventilated areas. Now, these good areas have plenty of room to expand. And this can help you breathe easier.

It involves a “minimally invasive procedure.” You are given medicine so you don’t know it’s happening. A bronchoscope is put into your airway. Areas of your lungs are tested.  The valves are put into areas that are poorly ventilated.2-3

What to make of this?

It’s a very new procedure. Study results were very promising. They showed decreased shortness of breath after the procedure. They also showed a reduction in COPD flare-ups and hospital admissions for COPD. So, there was good evidence supporting the FDA approving EVS for severe emphysema.1-3

A fellow respiratory therapist said she saw it work first hand. She had a patient with severe emphysema. He was very short of breath. So much so he wasn’t able to lie flat. He then underwent the procedure. My coworker said she entered his room. He was lying flat and sleeping comfortably. She woke him up. She said, “He never would have been able to do that before his procedure.”

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. FDA Approves Zephyr Endobronchial Valve For Treating Severe Emphysema,” https://www.pulmonx.com/en/ous/news/fda-approves-zephyr-endobronchial-valve-for-treating-severe-emphysema/?no_cache=1, accessed 1/20/19
  2. Brooks, Megan, “FDA Clears Zephyr Endobronchial Valve To Treat Severe Emphysema,” 2018, June 19, Medscapes, https://www.medscape.com/viewarticle/898721, accessed 1/29/19
  3. Molano, Alberto, "Endobronchial Valve System Now Approved in US for Treatment of Severe Emphysema," COPD News Today, 2019, January 4, https://copdnewstoday.com/2019/01/04/endobronchial-valve-system-fda-approved-emphysema/, accessed 1/29/19

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