Africa’s first endoscopic lung volume reduction (ELVR) procedures using endobronchial valves were recently performed at Netcare Kuils River Hospital in Cape Town. This treatment, which is offered by several healthcare facilities around the globe, gives hope of improved quality of life to certain patients living with chronic obstructive pulmonary disorder (COPD).
The procedures were performed by pulmonologists Professor Coenie Koegelenberg and Dr Dante Plekker who both practise at Netcare Kuils River Hospital. Prof Koegelenberg is also a professor in the Division of Pulmonology at the Department of Medicine, Stellenbosch University and Tygerberg Hospital.
Not being able to breathe makes everything difficult
“COPD is a chronic lung disease that usually occurs in current or former smokers. Typical symptoms include breathlessness, coughing and wheezing caused by varying degrees of damage to the small air sacks or alveoli – resulting in emphysema as well as chronic inflammation of the airways.
“This leads to an inability of the lungs to empty completely when exhaling causing the lungs to become hyperinflated with less space in the chest to breathe with. The condition can cause debilitating breathlessness, even during minimal daily activities such as washing and dressing, resulting in a poor quality of life. Typical treatment of COPD includes smoking cessation, inhaled medications as well as pulmonary rehabilitation. Despite this many patients continue to suffer from severe symptoms. In these patients ELVR can be considered as an additional treatment option,” notes Dr Plekker.
A closer look at ELVR
According to Professor Koegelenberg multiple high quality clinical trials have indicated that ELVR can improve symptoms as well as lung function, thereby enhancing quality of life in patients with COPD and emphysema who meet the selection criteria to undergo the procedure.
“During this minimally invasive procedure a flexible fibreoptic camera or bronchoscope is used to insert small one way valves into the lobe of the lung that is most impacted by disease. This aims to deflate the treated lobe so that airflow can be redirected to healthier parts of the lungs. The procedure reduces hyperinflation and improves the mechanics of breathing. It however does not cure COPD or emphysema.
“Appropriate patient selection is vital to the success of this treatment. Before the procedure can be offered patients need to undergo a rigorous clinical as well as physiological workup including complete lung function tests.
Additionally, a high resolution CT scan of the lungs is required which is assessed with a specialized software programme to determine if a suitable lobe is present for treatment. Previous clinical trials have clearly shown us in which patients ELVR is potentially beneficial. We therefore recommend that patients with COPD or emphysema should discuss this new treatment option with their pulmonologist.”
Both the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines as well as the United Kingdom National Institute for Health and Care Excellence (NICE) advocate the use of endoscopic valves in appropriate patients. The South African Thoracic Society has also recently updated its guideline for the appropriate use of ELVR. The two procedures that were performed in South Africa were both approved and funded by medical schemes.
A tale of two patients
A few days after becoming the first patient in Africa to undergo endoscopic lung volume reduction (ELVR) at Netcare Kuils River Hospital, 66-year-old Charmaine Henning, who was diagnosed with severe COPD in 2019, noticed a significant improvement in her breathlessness.
For Mrs Henning, this comes after years of illness that left her unable to perform even the most basic activities without pausing to catch her breath. “I cannot believe it but the very next day, even that very same afternoon after the procedure, I could feel a difference,” she recalls. “Before my procedure I was terribly tired. I could not walk the few steps from my room to the en suite bathroom without having to sit down. When speaking to someone I had to ask them to hold on so I could get my breath back – but just listen to how I am talking to you now!
“I’m so proud of the two of them – Dr Plekker and Professor Koegelenberg – they did the procedure fantastically and I know it was not easy. I also want to thank the entire team, anaesthetist Dr Gareth Davies, the nurses and everyone else. Now, every morning when I wake up, I think how amazing it is that things changed so quickly for me after the procedure. My family cannot believe that I am not out of breath,” says the mother of two and grandmother of six.
72-year-old Chris Ryan, a British citizen, underwent the ELVR procedure on the same day as Mrs Henning, and spent a few additional days recovering in hospital. Initially Mr Ryan, who was diagnosed with COPD nine years ago, was contemplating having the procedure done in Britain, however, due to pandemic induced delays, a long NHS waiting list and the prohibitively high cost of a private procedure alongside a lengthy recovery period in London, this was a difficult option to pursue. When the news came that the procedure could now be provided locally Mr Ryan did not hesitate to book a consultation in the hope that he would be a suitable candidate.
“My wife and I are very glad that I have finally been able to have the ELVR done, as I have had quite a few exacerbations that have landed me in hospital and intensive care through the years. Now I am feeling better and have noticed an improvement in my breathing which will have a positive impact on the quality of my life. I know that it will take a while before everything settles down completely, but I will know for sure how much progress I have made when I see the doctors for a follow-up visit and a proper lung function test in June,” says Mr Ryan.
“COPD remains one of the most common causes of morbidity and mortality in South Africa. The availability of ELVR is a medical breakthrough for the African continent and South Africa and we really hope it will become more and more widely used here. More importantly, it is a procedure that brings hope to those who were previously in the unenviable position of having no treatment options available to improve their quality of life,” concludes Professor Koegelenberg.
Notes to editor
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