In a continent first, 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. Koegelenberg is also a professor in the Division of Pulmonology at the Department of Medicine, Stellenbosch University and Tygerberg Hospital.
Being unable to breathe makes everything difficult
“COPD is a chronic lung disease that usually occurs in current or former smokers," said Plekker.
“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.”
A closer look at ELVR
Koegelenberg said 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 most impacted by disease. This deflates 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. However, it 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, assessed with a specialised 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 at Netcare Kuils River Hospital, Charmaine Henning (66) who was diagnosed with severe COPD in 2019, noticed a significant improvement in her breathlessness.
The procedure followed years of illness that left her unable to perform even the most basic activities without pausing to catch her breath.
“The very next day, even that same afternoon after the procedure, I could feel a difference,” she said. “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.
“Dr Plekker and Professor Koegelenberg did the procedure fantastically and I know it was not easy. Thanks also to the entire team, anaesthetist Dr Gareth Davies, the nurses and everyone else.”
Chris Ryan (72) a British citizen, underwent the ELVR procedure on the same day as Henning, and spent a few additional days recovering in hospital. Initially, Ryan, who was diagnosed with COPD nine years ago, considered 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 be provided locally, Ryan immediately booked a consultation in the hope that he would be a suitable candidate.
“My wife and I are very glad I have finally had the ELVR done, as I have landed in hospital and intensive care several through the years. I have noticed an improvement in my breathing, which will have a positive impact on the quality of my life.”
COPD remains one of the most common causes of morbidity and mortality in South Africa, said Koegelenberg. “The availability of ELVR is a medical breakthrough for the continent and South Africa, and we hope it will become more widely used here. More importantly, it is a procedure bringing hope to those who were previously in the unenviable position of having no treatment options available to improve their quality of life.”
Issued by MNA on behalf of Netcare Kuils River Hospital