tiny bell that breathes life back into your lungs?

 

Me and my operation: The tiny bell that breathes life back into your lungs

By Angela Epstein

Every year 900,000 Britons are diagnosed with lung conditions such as emphysema and chronic bronchitis which leave them breathless. Susan Matthews, 62, a retired administrator from Wiltshire, underwent a new, non-invasive treatment.

THE PATIENT

And breathe: A bell-shaped valve has transformed the life of one emphysema sufferer

Twelve years ago, I started feeling breathless when I was walking uphill or for long distances.
At the time I assumed I was just out of shape: as an administrator my day was fairly sedentary. I’d also, ashamed as I am to admit it, smoked on and off for the previous 20 years — up to 20 cigarettes a day.
The breathlessness got worse, and five years after the symptoms started I went to see my GP. By this stage I was gasping for breath.
I was referred to a consultant who diagnosed emphysema, where the lungs become inflamed — when I breathed in, the air was getting trapped and wasn’t being exhaled.
Over time the air builds up, taking up more and more space in your lungs so you can’t take as much air in — that’s why I’d been feeling so breathless.
Although both lungs were affected, the left was more damaged. The consultant said unless it was treated it would just get worse and could even be fatal as the lung tissue is gradually destroyed.
I was horrified, though in my heart I knew this was because I’d been stupid enough to be a smoker. Of course, I stopped completely straight away.
The consultant said the only treatment was to operate to deflate the damaged lung permanently, but because my breathing was so bad I just wasn’t well enough for surgery.

 

My breathlessness was getting steadily worse and it got to the stage when it was impossible to walk to the shops or even upstairs.
I also started to get chest infections every few months. I barely wanted to go out because everything was such an effort and I was so reliant on my husband, Brian, and our daughter Rhiannon, 31.
Then, last autumn, I was told about a new non-invasive procedure. The surgeon would put a tiny, bell-shaped valve down my throat and into the damaged part of my lung so the trapped air could be released, making it easier for me to breathe in and out.
The valve works one way so that when you breathe in it doesn’t allow air to the damaged part of the lung, yet it allows air out when you exhale.
I was terrified at first. But my consultant, Ms Kornaszewska, reassured me there was very little risk of complication since I wasn’t having a general anaesthetic or open surgery.
Anyway, by now I had so much trouble breathing that I could barely talk or get out of a chair without gasping. I couldn’t face going on the way I was.
I had the two-hour operation under sedation at Heath Hospital in Cardiff in October 2011, and was kept in for five days.
I had a sore throat when I woke up, but, remarkably, I wasn’t out of breath any more.
Since then, life has changed for the better. I enjoy walking again, going to the theatre and playing with my nine-year-old grandson, Cameron. They’re just normal things, but it’s so easy to take them for granted. 

THE SURGEON

Margaret Kornaszewska is a cardiothoracic surgeon at University Hospital, Wales.
Chronic obstructive pulmonary disorder (COPD) — the umbrella term for lung conditions such as emphysema — is a very widespread problem.
In fact, recent research suggests it may be hugely under-diagnosed — as many as one in ten people over 40 in Britain may have a form of COPD. More people die each year from these lung conditions than from breast and prostate cancer together.
The condition is linked to smoking, exposure to cigarette smoke and jobs such as mining or the chemical industry, but it can also be caused by earlier serious chest infections.

Normally, when we breathe in, air travels down the main airway, the trachea, into microscopic air sacs in the lungs called alveoli. Here, oxygen is absorbed into the blood before the air is breathed out.
When someone develops emphysema or chronic bronchitis, some of these microscopic air sacs become damaged. This means that not all the air that should be expelled is actually breathed out and about 10 per cent of it remains trapped in the lungs.
As a result the lungs become overinflated over time and there is less space for taking air in. The body compensates by taking shorter breaths, leading to breathlessness. The lung tissue can become so damaged that the condition can be fatal.
Operating to reduce this over-inflated area of the lung is thought to be the best way to resolve the problem. 

However, this is quite risky since emphysema patients are already unwell. It also means a long hospital stay and, as with all operations, carries the risk of infection.
Endobronchial lung volume reduction can achieve the same results, but with a minimal risk of complications as there’s no open surgery involved.
It involves placing a one-way, bell-shaped valve (about 10mm long and 5mm wide) in the bronchi, the tubes that run into the alveoli, in the most over-inflated part of the lungs.

When the patient breathes in, the valve closes and prevents air being directed to the damaged part of the lung, so preventing further inflation.
However, when the patient breathes out, trapped air is able to flow through the valve and out of the lung. This improves the patient’s ability to breathe, and of course it allows them to be more active, which improves their overall wellbeing.
Depending on a patient’s condition, the number of valves used can vary from one to 15. 

The procedure was trialled at the Royal Brompton Hospital, West London, around two years ago, and is available in a limited number of NHS hospitals, but there are plans to make it more widely available.
With the patient under sedation, I place a special camera on a tube (a video bronchoscope) down the mouth and directly into the damaged area. This transmits images of the lung onto a computer screen so that I can see exactly where to place the valve.
The valve, which is made of mesh, is then compressed into a catheter (a thin tube) and put down the throat.
Once guided to its exact location, the valve is pushed out of the catheter where it expands to its full width. The valve creates an airtight seal against the wall of the bronchi to prevent air from leaking around the device.
The valve stays in place because of internal pressure in the body, so then we simply withdraw the catheter and camera back through the mouth.
As there’s no invasive surgery there is no risk of infection, no need for painkillers and the effects are almost immediate.

The procedure costs £10,000 to £15,000 privately, depending on the number of valves used, with a similar cost to the NHS.

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