Research has shown that exercise can improve breathing among people with a respiratory disease, but participating in any type of physical activity while your lung function progressively declines is not an enjoyable experience. A recent study conducted at 10 university hospitals in France has come away with a minimally invasive surgical intervention that could lead to significant improvements in exercise capacity. This technique involves fitting lungs with bilateral coils using an endoscope.
"As further refinements in radiologic and clinical characterization progress, clinicians could expect to be able to offer even greater clinically based 'precision medicine' in matching a given technologic intervention to specific patient characteristics," wrote Dr. Frank C. Sciurba, from the University of Pittsburgh, in an accompanying editorial. "Even though this approach may ultimately result in fewer patients eligible for treatment, those who receive treatment will be likely to have a more predictable therapeutic response. Furthermore, this improved efficiency could serve to translate into greater cost-effectiveness.”
According to the Centers for Disease Control and Prevention, emphysema is a disease associated with airflow blockage and breathing-related problems that falls under the Chronic Obstructive Pulmonary Disease (COPD) umbrella. Specifically, emphysema is characterized by lung tissue elasticity and hyperinflation, dyspnea (shortness of breath), exercise limitation, and an impaired quality of life. There are an estimated 4.1 million people in the United States living with emphysema.
A research team led by Dr. Gaetan Deslee from the Hospital Universitaire de Reims in France recruited 100 patients with severe emphysema. Half of the patients were assigned to usual care, which included rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen, while the other half was given the bilateral coil treatment, which meant having 10 coils per lobe placed into two bilateral lobes over the course of two procedures.
Among the 50 patients assigned to the bilateral coil groups, 18 experienced an improvement of at least 59 yards in a six-minute walking test six months after the implantation, compared to just nine patients from the usual care group. Patients in the coil group also experienced substantial decreases in lung hyperinflation and improvements in quality of life. Unfortunately, the average cost to treat patients in the coil group was $47,908 more than the usual care group.
"This cost-effectiveness ratio at one year and modeled to three years would not be considered efficient enough to warrant adopting the technology by most countries," the authors said in a statement. "Implementation of this technique in a large-scale emphysema population is likely to require this additional data given the high per-patient cost in the short run and the uncertain effect on total health care expenditures. Further investigation is needed to assess durability of benefit and long-term cost implications."
Evidence has shown that millions of Americans could be living with undiagnosed lung disease — unaware because of unreliable lung-function tests. Studies have also found combination therapies that include more than medication are the most effective treatment options for COPD. While the bilateral coil treatment is non-surgical, lung volume reduction surgery is another emphysema treatment that involves using a bronchoscopic intervention and nitinol coils to induce volume reduction and restore lung recoil. However, unlike this new bilateral coil intervention, lung volume reduction surgery has been associated with significant illness and death.
“Lung volume reduction surgery usually involves surgical stapling, laser ablation, or some combination of those to reduce lung volume,” Chris Sampson, Director of Corporate Communications at BTG – the developer of this new coil treatment – told Medical Daily in an email. “Treatment with coils is a non-surgical procedure that is less invasive than lung volume reduction surgery and designed to provide similar benefits in a much broader group of patients. The coils improve elasticity by re-tensioning the lung’s airways, which may help prevent small airway collapse and reduce hyperinflation.”
Source: Mal H, Dutau H, Deslee G, et al. Lung Volume Reduction Coil Treatment vs Usual Care in Patients With Severe Emphysema: The REVOLENS Randomized. JAMA. 2016.