New Study Examines Preferences and Treatment Options in Patients with Severe Emphysema

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Sometimes making a decision is easy and sometimes it’s not. Often, the more major a decision, the more we may find ourselves weighing the pros and cons, the risks and benefits, before committing to a way forward.

This is often the case when faced with making a medical decision about treatment. In some cases, the options are very clear and the decision easy. In other cases, however, more risk may be associated with a particular treatment, especially if the treatment option is new, which can make the decision all that more difficult.

For individuals with severe emphysema, making decisions about treatment options is challenging because there aren’t that many treatment options available. Lung volume reduction surgery is one such option but not all patients are appropriate candidates and the surgery carries a high morbidity rate. Medical management, pulmonary rehabilitation and long-term oxygen therapy are also standard treatments, but patients often remain symptomatic.

Bronchoscopic lung reduction is another option, but until recently this treatment has only been available to patients outside the United States (US). In the summer of 2018, however, the US Food and Drug Administration approved Zephyr® endobronchial valves for clinical use in the US. The small endobronchial valves are inserted into diseased portions of the lungs. The “one-way” valves allow trapped air and fluids to escape from the diseased airway but prevent air from entering. By essentially reducing the volume of the lungs (as done similarly with lung volume reduction surgery) the healthier portions of the lungs expand better and function more efficiently—with the goal of helping patients breathe easier. The valves are inserted into the lungs via a bronchoscopic procedure (i.e., a flexible bronchoscope tube is inserted into either the mouth or nose and down the throat into the airways of the lungs).

In a recent study published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, patients’ preferences for emphysema treatment options—including the new endobronchial valves, lung volume reduction surgery and medical management—were measured. In “Patient Preferences for Endobronchial Valve Treatment of Severe Emphysema” the authors state, “[l]ittle is known about patients’ willingness to accept risks for new treatments that offer meaningful benefits.”

Individuals with a self-reported diagnosis of emphysema, 18 years or older with no previous lung volume reduction surgery and a 2+ score on the modified Medical Research Council Dyspnea Scale were recruited through the COPD Foundation’s COPD Patient-Powered Research Network.

Participants in the study were asked to complete a web-based survey which asked them questions about their preferences for 2 hypothetical interventions—lung volume reduction surgery and endobronchial valves—versus current medical management. “Variations in 5 attributes defined the 2 interventional treatments: improvement in ability to breathe and carry out day-to-day activities, frequency of hospitalized exacerbations, treatment type, risk of pneumothorax within 30 days of procedure, and risk of death within 3 months.”

The results indicated that on average, “respondents preferred the hypothetical interventional treatments over current treatment, and they preferred an interventional treatment with ‘removable valves’ [EBVs (endobronchial valves)] over ‘surgery’ [LVRS (lung volume reduction surgery)].” More specifically, “among 294 respondents, 51% always chose an interventional treatment option, while 19% always selected continued medical management. The most important change on average was moving from continued medical management (with no improvement in breathlessness) to an interventional treatment with improvement in breathlessness.”

The authors concluded that individuals “with severe emphysema perceive that a procedure with risks and benefits similar to the [endobronchial valve] implants is desirable over continued medical management or [lung volume reduction surgery].”

To read the journal article in full, click here:

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  • I had this conversation with my pulmonlogist and his reply back to me was an eye opener. He told me that i was most likely a strong candidate for this new valve, but he stated that he was worried about the danger of pneumothorax occurring. As usual I stop dead in my thought process and had to ask myself is the risk worth it? Never easy choices when it comes to COPD.
  • This is an in depth including adverse reactions. From ATS Journals
    "A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE)"

    It is a difficult decision at best. I am heading to see Dr. Criner at Temple University Lung next Thursday. If I am a good candidate or not has yet to be determined. I have moments where I think to myself, why would I do it, why risk complications. Then I have moments where I am short of breath trying to do the simplest of things and I think to myself, I sure could use a break.

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