Forty-minute wonder op gets damaged lungs working again

LUNG ‘REDUCING’ SURGERY TO TREAT EMPHYSEMA

THOUSANDS of Britons have breathing difficulties due to emphysema, but a new procedure could help them. Richard Kerswill, 53, a retired school caretaker who lives near Aylesbury in Bucks, took part in a trial of the treatment, as he tells CAROL DAVIS.

THE PATIENT

FoR my job I used to walk miles up and down corridors every day. I did i t without any problems, but five years ago I started feeling breathless all the time, as though there were bricks piled on my chest.

Cold air made it worse. one october night, I was out with friends and was struggling for breath. I then just collapsed, which was terrifying. An ambulance took me to A&E where doctors gave me oxygen and an inhaler until I felt better.

they thought it might have been a panic attack, but my partner, Wendy, and I were puzzled — I’d never had one before.

It happened several more times over the next five months, always in cold air — each time, I’d be rushed to hospital by ambulance. I was sent for X-rays, but no one could work out why it was happening.

then the next time I went to A&E the consultant ordered a Ct (computerised tomography) scan. this showed I had advanced emphysema — where the tiny air sacs in your lungs become damaged and the walls between them break down.

the consultant said emphysema also meant my lungs had become less elastic. this was why breathing was much harder.

He blamed smoking. I was devastated, as I’d given up a few years earlier after a 20-year habit.

I was given inhalers to help my airways relax so I could breathe more easily. but it gradually got worse over the next six months. I’d have to pause for breath while walking, and stay indoors when it was cold. And I kept getting lung infections.

the school was great, but I had to take early retirement.

I had regular tests at a specialist hospital — the Royal brompton in London — the doctors told me about a trial they were running using a new device to make the lungs work better so I could breathe more easily.

they’d put tiny metal coils into my lungs, which would compress the diseased areas, so the healthy tissue could work better.

It sounded amazing. I had the operation in July 2011 at the Chelsea & Westminster Hospital in London — it took only 40 minutes. I was sedated but awake while the consultant Dr Pallav Shah fed the coils into my right lung using a flexible tube, which went in through my mouth and down my throat.

I was groggy afterwards, but there was no pain. I stayed in overnight, then just walked to the taxi.

And I couldn’t believe the instant difference — the tightness in my chest had eased so I could go shopping with Wendy.

A month later I had the coils implanted in the left lung, too, and felt even better.

Cold air still affects me, but I’d like to see this offered to many more people, because it could save them a lot of misery.

THE SPECIALIST

dR PAllAv ShAh is consultant physician in respiratory medicine at the Royal Brompton and Chelsea & Westminster hospitals in london. About 10 per cent of people over 50 have chronic obstructive pulmonary disease, or CoPD. A common form is emphysema, which affects up to 100,000.

Emphysema is mainly caused by smoking. other causes include coal pollution.

Instead of being like a sponge, containing many tiny air sacs, the inflammation caused by smoking means that the collagen and fibres separating these air sacs are progressively broken down; causing the sacs to form larger pockets.

the sacs are where oxygen and carbon dioxide are taken into the lungs or passed out. but because their surface area is reduced, stale air becomes trapped, causing the lungs to over-inflate over time.

Airways i n the l ungs also become floppy and less elastic, so patients feel they cannot breathe — and because the larger, stretched lungs put pressure on the diaphragm, the main breathing muscle, it also becomes less effective.

this is unpleasant and debilitating, and can become life-threatening.

THE first thing patients should do is stop smoking. We can give them i nhalers c ontaining short-acting or long-acting bronchodilator drugs, which relax muscles in the lungs and widen airways, and steroids to reduce inflammation. Special exercises can improve overall fitness to help them breathe more easily.

Patients with severe emphysema may also be offered lung volume reduction, to remove damaged parts and allow the healthy parts to inflate properly.

but this is major surgery with a risk of serious complications including respiratory failure, infection or blood clots.

We can also use valves to close off the damaged areas of the lung. but both surgery and valves work when only part of the lung is damaged, and there are other good areas of healthy lung to compensate.

this applies only to 10 to 15 per cent of patients with emphysema because the damage is usually widespread.

but now there is a new treatment, devised in the u.S. in 2007. Known as RePneu lung volume reduction coils, the treatment consists of coils made of nitinol (an alloy of nickel and titanium which doesn’t corrode) up to 150 mm long (twice the size of a paperclip).

A sheath initially keeps them straight, but when released, they spring into coils.

When inside the lungs, the spring gathers up and compresses the diseased tissue. this tightens the healthy areas, so they can function better — like pinching the end of a partly deflated balloon to make it firmer.

As we are not removing any tissue, this procedure is suitable for cases of widespread damage.

We have completed t he device’s first randomised controlled trial, Reset, and are recruiting for a second.

the trial has had good results, with most of the 50 patients seeing significant improvement i n exercise capacity, l ung function and quality of life. the procedure carries some risks, including bleeding and risk of a punctured lung (this happens in 3 to 4 per cent of cases), which we would then have to re-inflate with a tube into the chest. there is a 0.1 per cent risk of mortality.

the procedure takes 30 to 40 minutes under sedation. First, we put a local anaesthetic into the throat. using X-rays to guide us, we then put a bronchoscope (a telescope that allows us to visualise the airways) into the lungs, via the mouth and down the throat.

We then feed ten to 12 coils into the diseased areas — there are different sized coils, depending on the size of the patient. they will stay there indefinitely.

We hope this will one day offer another treatment option which could improve the quality of life for thousands of patients and possibly help with other lung conditions, too.

ANY DRAWBACKS?

‘RISKS of this procedure include a collapsed lung, which can happen in patients with CoPD anyway — you then need to put a tube in through the ribs to release trapped air,’ says Anthony De Soyza, senior lecturer at the university of Newcastl e and honorary consultant physician at the Freeman Hospital in Newcastle.

‘there’s also a small risk of infection from the bronchoscope in the lungs, and a theoretical risk of damage to blood vessels. but these coils have a soft end and there is a reduced blood supply to damaged sections of lungs anyway.

‘Although the Reset trial was small, patients had a dramatic improvement in their quality of life, and much better than we achieve with inhalers.’

ThE procedure is only available on the NhS as part of the Renew trial at Royal Brompton hospital and the Chelsea & Westminster, london. Patients can be referred by their GP. To find out more, visit rbht.nhs.uk/research.