For patients with severe emphysema, Stanford Health Care provides valve to aid breathing

The day Joanne Eddy arrived at Stanford Health Care – ValleyCare to pick up her husband, Allen Eddy, after a lung procedure in September, she almost gasped. 

“I didn’t recognize him,” she said. “His eyes were bright, his skin color looked amazing. He just looked much healthier.”

“God, you look good,” she said. 

Eddy, 70, has a severe case of emphysema, which had made it difficult for him to breathe. He underwent a procedure to insert devices called Zephyr valves into the diseased portion of his upper left lung lobe. He had no idea they would help so much. 

“When I came out of recovery, I had no soreness or problems breathing,” Eddy said. That was on a Tuesday. “On the following Monday, I was able to golf nine holes with easy breathing and without using my inhaler once,” he said. Even better, he can now play with his grandchildren more often without losing his breath and needing to sit down.

Stanford Health Care – ValleyCare, in Pleasanton, was among a handful of hospitals to first use the Zephyr valve, which was approved by the Food and Drug Administration in June of 2018. Pulmonologist Chirag Pandya, MD, has inserted the valves, each about the size of a fingertip, into the lung airways of about a dozen of his patients, including Eddy, at Stanford Health Care – ValleyCare. Several more patients have been treated with the devices at Stanford Health Care in Palo Alto.

Emphysema affects patients’ day-to-day lives, Pandya said. “The lung damage is irreversible, and other treatments, such as inhalers, don’t always work well,” he said. “It’s great to have a new option.”

Damaged alveoli

Emphysema is a type of chronic obstructive pulmonary disease caused by damage to the alveoli, air sacs in the lungs. The condition primarily results from smoking or exposure to toxic fumes, Pandya said. Air gets trapped in the damaged alveoli and can’t be exhaled, which causes these parts of the lungs to permanently expand and put pressure on healthy parts of the organ, making it difficult to breath. People with the disease often feel tired because of insufficient levels of oxygen circulating in the blood. The Centers for Disease Control and Prevention estimates that 3.5 million Americans have been diagnosed with the condition.

“It was really exciting when this minimally invasive procedure came along,” said Meghan Ramsey, MD, clinical assistant professor of medicine at Stanford. “It’s a straightforward procedure that is done in one day. Patients are usually hospitalized for two or three days to monitor for any complications.”

Other treatments for severe emphysema include medications and inhalers. When those don’t work, surgery to remove the damaged portion of the lungs is an option. Lung transplantation is another option. But many patients are too sick for these more invasive surgeries, Pandya said.

The FDA approved the Zephyr valve based on data from a one-year, randomized clinical trial of 128 patients with emphysema. Results of the trial showed a 15 percent improvement in pulmonary capacity among 48 percent of those patients treated with the valve, compared with an improvement of 15 percent in only 17 percent of the control group. Stanford was one of the clinical trial sites.

Concept behind the Zephyr valve

“What we’ve learned is that air can get trapped in the damaged portion of the lung for years and years,” Pandya said. “The lung balloons full of air and you can’t breathe it out. If you could find a way to prevent air from going in, while allowing it to come out, that pressure could be relieved.”

That’s the concept behind the Zephyr valve. Using a flexible bronchoscope, a doctor usually places several one-way valves in the diseased portion of the airways. When the patient breathes in, the valves close, preventing air from entering. During exhalation, the airways open again, releasing the trapped air.

Eddy, now retired, was a smoker. He also was exposed to toxic fumes from welding in his job as a plumbing contractor. He was diagnosed with emphysema about five years ago when he nearly died from a case of pneumonia. He has used inhalers and taken other medication with varying degrees of success. But when Pandya recommended he try the Zephyr valve, he jumped at the opportunity.

After the insertion of three Zephyr valves, his use of inhalers has significantly decreased, and he feels more energetic, he said. Less than a month after the procedure, he golfed a full 18 holes, walking the entire way for the first time in years.

“I felt like a human being again after finishing that 18 holes,” he said. “It’s been such a relief to know that I can breathe again.”