Freezing their lungs can help ex-smokers breathe more easily
THOUSANDS of people suffer from chronic bronchitis and while there is no cure, a new procedure may improve the symptoms. Jayne Hewitt, 49, from London, was the first person in the UK to undergo it, as she tells ADRIAN MONTI.
THE PATIENT
BREATHING problems have affected me since I was a child. At 12, I was diagnosed with asthma, which got worse as I grew older. It didn’t help that I started smoking at 13, eventually having 20 a day, even though I knew it was bad for my lungs.
My breathing became so bad that in 2009 I had to give up my job as an administration officer. getting to work and speaking to people was difficult because I was so breathless.
In 2012, Dr Pallav Shah, my respiratory consultant, diagnosed chronic bronchitis. The airways to my lungs had been so badly damaged by my smoking that they were permanently inflamed, producing extra mucus. This is what was making me breathless.
Dr Shah said it would get worse over time. Although the diagnosis didn’t come as a surprise, it wasn’t good to hear. I was given medication to make the mucus easier to cough up, and was taught exercises to improve my breathing.
Doctors were also always urging me to give up smoking, which I finally managed two years ago.
But the damage had been done. everything became a huge struggle — I’d even get breathless making the bed, and my partner Paul had to help me in and out of the bath. I was constantly coughing to try to clear the mucus, and suffered lots of chest infections.
My chest felt as if it had a heavy weight on it, and I had memory lapses because my body and brain wasn’t getting enough oxygen. I also had poor digestion and circulation. The whole thing made me feel depressed.
When I saw Dr Shah in March this year, he told me about a new treatment he’d been researching, using liquid nitrogen to freeze some of the cells that produce mucus in the airways. This would mean I wouldn’t produce as much and my breathing would become easier.
They insert the nitrogen via a tube down the throat.
Dr Shah said it was the first treatment to tackle the causes of chronic bronchitis rather than just the symptoms, and I was keen to try it.
I had tests a week later to check I was suitable — which I was, because I had given up smoking and was producing a lot of mucus. They would do the procedure in stages, starting with my lower right lung.
Doctors would take biopsies beforehand and 60 days afterwards, so they could monitor how well it had worked.
I had the first session in March at the Chelsea and Westminster hospital under general anaesthetic. I woke up with a mild sore throat and went home that day.
So far only a small section of my airways has been treated but I feel a big improvement already.
I can move around and breathe more easily. I don’t sound as hoarse when I speak, and I don’t have as much mucus.
This month, the airways to my upper right lung will be treated, and later this year they will treat my left. I’m sure it will feel like having a new pair of lungs. THE SPECIALIST Dr Pallav Shah is a consultant respiratory physician at london’s Royal Brompton hospital and Chelsea and Westminster hospital.
There are about 900,000 people in Britain diagnosed with chronic obstructive pulmonary disease, a collection of lung diseases.
The most common is chronic bronchitis, which is most prevalent in men over 40.
With this condition, longterm exposure to irritants, such as tobacco smoke, causes the airways to become inflamed and produce more mucus than normal. The inflammation and excess mucus reduces air flow, causing coughing and shortness of breath.
eventually this can lead to permanent lung damage.
The condition is different from acute bronchitis, which is caused by an infection and lasts only a few weeks.
In 90 per cent of cases the cause is smoking, but other irritants such as chemicals and dust can have the same effect. When people smoke, the noxious chemicals in cigarettes knock out the tiny cilia hairs that line the airways. These hairs play a vital role in clearing mucus.
Smoking also affects mucus production. Mucus is made by cells — called goblet cells — on the epithelium, which is the top layer of tissue on the airways.
SMOKING damages the goblet cells, meaning they start to make large amounts of mucus, which the cilia cannot move effectively.
It usually takes years before a smoker develops chronic bronchitis, but once they have it, it’s as if a switch is broken, so they keep producing excess mucus even if they stop smoking.
The big challenge is how to treat the condition and not just the symptoms.
Until now, all we’ve been able to offer is medication such as carbocysteine, which thins the mucus and slows production of it.
This new approach — which we are trialling at the royal Brompton hospital and Chelsea and Westminster hospital — is designed to treat the excess mucus production, which is a much better solution.
We are offering it only to patients who have stopped smoking, otherwise the symptoms would start again.
It is a variation on a procedure developed in the U.S. to treat some cancerous lung tumours, where liquid nitrogen is used to freeze the diseased part of the lung.
We believe that by freezing and killing off the top layer of cells in the damaged airway, the stem cells below — which have the potential to develop into new goblet cells — are preserved.
It means new, healthy cells can regenerate.
The technique we’re using — the rejuvenAir System — is more accurate than the cancer treatment in the way the liquid nitrogen enters the diseased cells.
Jayne had a general anaesthetic. Then a bronchoscope, which is a narrow instrument with a light and camera attached, was threaded down her throat into her airways.
A precise quantity of liquid nitrogen was passed down the tube inside it.
The liquid nitrogen is at about -196c, which instantly freezes and kills off all the goblet cells.
Because an exact dose is delivered, other cells are not damaged. Biopsies and scans will double check this.
In Jayne’s case, 19 sprays of liquid nitrogen were applied to the diseased part of the airways. The entire procedure took 30 minutes.
GREAT care is taken, because once liquid nitrogen leaves the bronchoscope it returns to its natural state as a gas. If this were to build up, it could endanger the patient by depriving them of oxygen.
So the patient has to be ventilated throughout the procedure with a tube to ensure the nitrogen escapes.
once the diseased tissue has been killed, new cells will regenerate and replace it within 48 hours.
We hope they will almost be as good as the ones you were born with.
At this stage we don’t know how long these regenerated cells will last. But it’s a fairly straightforward procedure to carry out again if needed. Patients shouldn’t feel any serious side-effects afterwards.
We’re treating this small section of lung to prove the technique is safe, before proceeding to the upper right airways of the lung.
our London team is working alongside one in the netherlands. each team plans to do a clinical trial on 12 patients and we later hope to carry out a larger international trial.