Gadget to treat collapsed lungs – from your sofa

ADEVICE that drains air from the chest is being used to treat thousands of patients who have suffered a collapsed lung – while they relax at home. The portable gadget, which is not much bigger than a ballpoint pen, slashes the time patients need to spend in hospital from three or four days to under an hour.

‘It is an absolute game-changer,’ says Dr Sam Hare, consultant chest radiologist at the Royal Free London NHS Trust. ‘It means patients who currently need treatment for a collapsed lung but fear being admitted to hospital because of coronavirus can go home in under an hour and keep shielding.’

Dr Hare and colleagues have so far treated an estimated 3,000 patients with the portable chest drain, but it’s estimated fewer than one in ten NHS trusts are using it.

Now NHS England is urging all hospital trusts to adopt it.

Collapsed lungs – known by the medical term pneumothorax – are relatively common. One of the most frequent causes are lung biopsies, where doctors remove a tiny bit of tissue to check for signs of cancer. Every year the NHS performs tens of thousands of them, but up to one in five results in a collapsed lung.

To reinflate it, doctors must first drain off the excess air that has collected in the chest and is compressing the lung. This has traditionally involved inserting a tube the width of a garden hose through an incision between the patient’s ribs and attaching it to a large bottle of sterile water. As the air escapes, it passes into the bottle and is trapped in the water so it cannot travel back up the tube. The whole process can take several days and leave a noticeable scar.

Owing to the high risk of complications, lung biopsies can be done only if a hospital bed is available should the patient need to be urgently admitted.

When treating a patient with a collapsed lung with the new device, doctors first inject local anaesthetic into the side of the chest and insert a tube no wider than a straw through the ribs. On the other end of the tube is a pen-sized device with a silicone valve inside it.

When the patient breathes out or coughs, the valve opens to let trapped air from the chest escape before snapping shut. It opens only one way – when they breathe in, air does not travel back up the tube.

To check air is being released, the patient pops the valve into a glass of water once or twice a day and deliberately coughs a couple of times. If bubbles appear in the water, it means there is still some air in their chest left to be drained.

When the bubbles stop, usually within 48 hours, it means the lung is fully reinflated and the patient returns to hospital to have the device removed.

Dave Knott, 76, a retired furniture dealer from Potters Bar in Hertfordshire, has twice benefited from the bubble-blowing valve. In February 2019, when he became breathless and lost weight, X-rays revealed a shadow on his right lung. A survivor of throat cancer and and having smoked, Dave feared it was a tumour.

Doctors took a biopsy, which made his lung collapse and he was immediately fitted with the portable valve and sent home.

Tests revealed it was not cancer but a severe bacterial infection, which was successfully treated with powerful antibiotics.

Earlier this year, X-rays revealed another shadow – on his left lung – and Dave was called to hospital for a second biopsy, in the middle of the coronavirus pandemic.

Fearing another collapsed lung, it was only the prospect of being in and out of hospital in under an hour that convinced him to go ahead.

‘I was very anxious because I am extremely vulnerable and have been shielding with my wife June for 11 weeks,’ he says. ‘I didn’t want to be admitted and risk coronavirus.’

On May 12, Dave had his second biopsy at Barnet Hospital – part of the Royal Free Trust – and his left lung collapsed. But within minutes a valve was fitted and he was sent home, and the bubbles subsided after a few days. Test results ruled out cancer – he had a severe fungal infection that was successfully treated with tablets.

Dave says: ‘The respiratory ward was right next to the Covid ward – which was terrifying. That valve spared me a risky hospital stay.’

Dr Hare says the technique is safe with few, if any, side effects and most patients don’t need painkillers. He says: ‘This simple innovation should be used much more widely.’