Bronchoscopic Lung Volume Reduction (BLVR) for COPD/Emphysema

Penn Interventional Pulmonology offers Bronchoscopic Lung Volume Reduction (BLVR) for patients with advanced COPD/emphysema who are not candidates for lung volume reduction surgery or lung transplantation.

The progress of emphysema and chronic obstructive pulmonary disease (COPD) is unremitting and prolonged. Outside of occasional exacerbations, patients with COPD and emphysema experience a consistent decrease in quality of life (QOL) as their condition worsens in severity that is so insidious that they often accept their symptoms and limitations as normal. Worse, with time and the continuing destruction of lung tissue, many feel that the disease can’t be treated or reversed.

Bronchoscopic Lung Volume Reduction for COPD

Much can be done to address the symptoms and effects of COPD/emphysema, according to Kevin Ma, MD, the Clinical Director of the Bronchoscopic Lung Volume Reduction Program at Penn Medicine.

Lung volume reduction surgery (LVRS), for example, is an advanced therapy that has the object of removing damaged lung tissue to allow the lungs to expand into the newly available space. A life-altering option for some, LVRS is not without issues, however.

“The NETT trial in 2003 proved that patients with severe emphysema affecting the upper lobes of both lungs do best with LVRS,” says Dr. Ma. However, he continues, this benefit is not available to patients whose disease is elsewhere in the lung, as well as those who don’t want the risk of surgery. For these patients, the only available options are lung transplantation and bronchoscopic lung volume reduction.

What is BLVR?

An option available at the Penn Harron Lung Center, BLVR involves implantable endobronchial, one-way valves that prevent re-inflation once air has escaped a targeted lobe. In a fully occluded lobe, this will cause deflation, leading to a reduction in air trapping and hyperinflation, allowing the better parts of the lung to re-inflate and the diaphragm to achieve a more comfortable position.

Because BLVR doesn’t require patients with COPD/emphysema to undergo major surgery, it has fewer risks and generally less restrictive inclusion criteria versus LVRS and lung transplantation. Moreover, endobronchial valves have been shown at 12 months following treatment to improve dyspnea, exercise tolerance, and QOL in selected persons with advanced COPD.

“We've had patients preparing for a lung transplant elect to come off the waitlist after BLVR because of how good they're feeling,” Dr. Ma says.

Criteria for BLVR: Who is a candidate?

“The best patients for BLVR are those with a diagnosis of COPD whose pulmonary function test shows severe hyperinflation and air trapping,” says Dr. Ma. “These patients should really come and see us if they're still having symptoms from their COPD.”

Patient Criteria for BLVR

To screen for eligibility, candidates for BLVR must ideally have had the following procedures within the last six months:

• Pulmonary function tests with lung volumes and diffusion capacity
• A 6-Minute Walk Test (6MWT)
• A high-resolution, non-contrast CT scan (1mm)

Further testing can be completed locally after consultation with the patient about the procedure.

In addition, candidates for BLVR should have had:

• Limited or no history of other lung diseases (ILD, bronchiectasis, etc.)
• Limited or no chronic bronchitis (excessive mucus, wheezing, frequent exacerbations) in the last six months
• Two or fewer COPD exacerbations in the last 12 months

Other considerations for candidates include the achievement of maximal medical therapy and smoking cessation for at least three months.

Preparing for BLVR

For clinicians unsure whether a patient meets the criteria for BLVR, Penn interventional pulmonologists can conduct the preliminary screening with a telemedicine appointment. Patients going through the evaluation process will also be assessed for candidacy for LVRS, alternative advanced therapies for COPD, and interest in lung transplantation.

Penn Medicine also offers a comprehensive smoking cessation program for all patients. The program provides a supportive, encouraging environment and a team of providers who meet patients where they are and does not rely on fear or shame to motivate patients to quit.

Clinical consult and patient referral

For questions about evaluation for bronchoscopic lung volume reduction for the treatment of advanced COPD, or to schedule a time to connect with the Penn Interventional Pulmonary service, please contact Erika Viggiano, BSN, RN, OCN, at 267-319-6439.

For additional questions or alternative Pulmonary Service access, please contact Kathleen Kratz, Senior Physician Liaison, at Kathleen.Kratz@pennmedicine.upenn.edu.

Associated resources

Listen to a podcast with Dr. Kevin Ma: Endobronchial Valve Placement for Emphysema/COPD: Breathing Easy Without Major Surgery