Emphysema is a common debilitating condition among chronic smokers and characterized by a constant sense of breathlessness, limiting their physical activity. In Hong Kong, it is estimated to affect between 6 to 8% of the elderly population (defined over 65 years old). Together with other chronic lower respiratory conditions, emphysema is the 5th leading cause of death.

　　Although medical therapy like bronchodilators and steroids are useful, they are often ineffective in relieving symptoms in the late phase of the disease. Lung volume reduction surgery was advocated ten years ago as the treatment for some of the patients with advanced emphysema who are already on maximal medical therapy. The theory behind this operation is that by removing the most emphysematous parts of the lungs, respiratory mechanics would improve. Although this operation has been shown to be effective in carefully selected patients, many have to be turned away because patients who are very sick with the disease would not be able to tolerate the surgery.

　　The Division of Cardiothoracic Surgery of the Department of Surgery at The Chinese University of Hong Kong is among the first in the world (and certainly first in Asia) to investigate a new device called the endobronchial valve (EBV) that can be placed through a bronchoscope into the segmental airway leading to the most emphysematous lung. The concept behind this is that the EBV would allow secretions from the targeted lung segment to escape, but air would not be able to get into the targeted lung. The resultant collapse would be equivalent to lung volume reduction surgery but without the trauma associated with surgery.

　　We have so far performed this procedure in 21 patients with no operative deaths. The stay in hospital after treatment is 5 to 6 days, whilst that of a surgery is 7 to 10 days. Full follow up data were available in 20 patients up to three months. We were able to demonstrate that in the majority of patients after the procedure, they were able to walk further, their lung functions significantly improve, and they overall feel much better. A complete report of this study will soon be published in the Journal of Thoracic and Cardiovascular Surgery. We will continue to investigate who would benefit most from this device, but this approach holds promise for the future treatment of a broader group of patients suffering from severe end stage emphysema.

endobronchial valve device

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