COPD: bronchoscopy instead of risky lung surgery
Jens Richter is editor-in-chief at Since July 2020, the doctor and journalist has also been responsible as COO for business operations and the strategic development of
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MunichPeople with severe COPD find it particularly difficult to breathe. Because in their chronically over-inflated lungs, the air accumulates in large bubbles and robs healthy lung tissue of space. For a long time, one way out was dangerous open lung surgery. In the meantime, however, there are gentler methods of treating what is known as pulmonary emphysema.
Some of the patients with severe emphysema of the lungs benefit from the "classic lung volume reduction" - especially when the upper areas of the lungs are over-inflated. However, surgery on the open chest is life-threatening for seriously ill patients, and patients repeatedly die in the weeks following the procedure. For many seriously COPD sufferers, the operation would actually be too great a risk.
Withdraw diseased tissue
For some years now, new, so-called minimally invasive surgical techniques have been gaining ground in which doctors use bronchoscopy to remove the pathologically altered parts of the lungs from circulation. There are essentially three techniques for doing this: Valves in the bronchi, which only allow air to flow into the emphysema areas, but not to flow in; Metal clasps (coils), which roll up after being inserted into the bronchi and cause the diseased lung parts to collapse, as well as bio-glue or water vapor, which shrink and atrophy the lung areas due to an inflammatory reaction.
Access via the trachea
What all the procedures have in common is that they can be used via an optically controlled tube, the so-called bronchoscope. A short general anesthetic is usually necessary for this, but the doctor can push the device through the patient's windpipe into the diseased bronchi - opening the chest is not necessary. Depending on the method, the abnormally enlarged lung tissue collapses within a few days to weeks and makes room for the healthy, still elastic lung tissue. This gives the most important respiratory muscle, the diaphragm, more space to work again - and healthy alveoli can better participate in gas exchange.
Almost every second person feels better
Studies show that the success rate of such operations is better than that of conservative emphysema treatment, which, in addition to medication, also includes learning certain breathing techniques (lip brake) and secretion-loosening physiotherapy. In 44 percent of patients, for example, after the insertion of mini-valves, respiratory flow, shortness of breath and resilience improve. And this procedure is even reversible: If complications arise after the operation, the small components can be removed from the bronchi.
Endoscopic emphysema operations are also not without risk. For example, bronchial mucosa can be injured (coughing up blood) or lung membrane damaged (risk of pneumothorax), secretion can build up in the deactivated lung areas and form a breeding ground for dangerous bacteria. The resulting so-called infection exacerbation is a dreaded complication in COPD.
Breathlessness as a constant companion
Pulmonary emphysema forms when the fine walls between the cluster-shaped alveoli are destroyed by the chronic inflammation in the lungs. At the same time, the air in the lungs builds up, because the swollen mucous membrane and the secretion in the diseased bronchi function like a valve. This means that air can still flow into the lungs, but when you exhale the bronchial walls collapse and keep the air trapped in the lungs.
Due to the constant overstretching, the alveoli merge into ever larger, inelastic bubbles, through which the exchange of oxygen and carbon dioxide hardly works. Pulmonary emphysema is particularly common in people with COPD. It leads to constant shortness of breath and a lack of oxygen and, in addition to recurring infections, is the greatest danger for COPD patients.
Sources:
A. Valipour et al .: "Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy", European Respiratory Journal 2013, doi: 1936.00133012
“Bronchoscopic Lung Volume Reduction” (brochure), published by COPD-Germany e.V. and the patient organization Lungenemphysema-COPD Germany
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