I was surprised by this statement, "25 to 30 percent of patients will experience a pneumothorax, or a collapsed lung when air enters the chest." No wonder they want patients well supervised.

By Anne Halliwell ahalliwell@rochestermagazine.com Apr 15, 2019

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Wayne Donald Peterson sat in the Gonda building with his portable oxygen concentrator resting by his feet.

Peterson, who previously needed 7 liters of oxygen a day, would only be able to take that portable unit out for about 45 minutes at a time before he needed to refill it.

“I couldn’t really go anywhere, it limited me,” he said.

Now, that portable oxygen concentrator lasts him all day, as he only needs about 2 liters of oxygen per day.

Peterson, 59, was diagnosed with COPD in 2003. Over the past 15 years, he developed advanced emphysema, which trapped air in damaged parts of his lungs, causing them to increase in size.

According to the CDC, about 16 million adults in the U.S. have COPD, and there is no cure. Tobacco use is the primary cause, but air pollutants and genetic disposition can also contribute to the disease.

The air in Peterson’s right lung didn’t benefit him, but made it impossible for him to take a full breath — there wasn’t enough room for the healthy parts of his lungs to expand.

“There was already air in it, so I could hardly take a breath,” Peterson said.

He was “in and out of hospitals” for several years, and on 24-7 oxygen for the last two.

Another chance

But on March 14, Peterson got another chance.

In mid-March, Mayo Clinic in Rochester was the first medical institution regionally to begin performing endoscopic lung volume reductions.

The procedure was approved by the FDA for clinical use in 2018. Only a few medical centers nationwide offer the treatment for chronic obstructive pulmonary disease (COPD), which alleviates some symptoms of advanced emphysema.

Using a small scope inserted through the mouth, doctors placed tiny valves in the damaged, over-inflated section of Peterson’s right lung to deflate that part. The rest of the lung could expand properly afterward.

The procedure should increase patients’ quality of life, Mayo Clinic pulmonologist Eric Edell said. There is not evidence that it increases length of life.

Endoscopic lung volume reduction is a minimally invasive procedure that should shorten hospital stays and result in fewer side effects and risks than surgery.

Since the procedure, Peterson hasn’t used oxygen when he sleeps, and his mobility has dramatically improved.

“I haven’t been able to get around like this in two years — over two years,” he said. “In 2017, I was living in Texas. They wanted me to go to hospice. Thought there was nothing more that could be done.”

Now Peterson, who’s back in his childhood hometown, Blooming Prairie, says he has the freedom to move away from the hospital, once he’s fully recovered.

The clinic does need to keep an eye on him for now, though, Edell said. The endoscopic procedure “does have some inherent risks with it,” he said — the biggest risk being the chance of a collapsed lung.

Tiny valves, big impact

The tiny valves placed in patients’ lungs let air out of the hyperinflated sections, but not back into those isolated lobes. Those sections are intended to collapse to make room for the rest of the lung to expand and function properly. However, 25 to 30 percent of patients will experience a pneumothorax, or a collapsed lung when air enters the chest.

Peterson said he recovered quickly from the procedure. However, Edell said patients are kept in the hospital for three to five days after surgery to monitor their conditions, even if they feel better and are moving more. They are monitored up to a month. The more of an unhealthy lung doctors collapse, the higher the risk of a pneumothorax — and the better the treatment for patients with emphysema.

“The reason they’re in the hospital isn’t because they’re suffering,” he said. “It’s so they aren’t out in the community if they have a pneumothorax.”

The endoscopic lung reductions aren’t an easy procedure, Edell said, which is why it’s being rolled out slowly. However, surgical lung reduction is a major procedure with a far higher morbidity rate.

In the end, endoscopic ling reductions are a great way for COPD patients who are approved for the procedure to improve their quality of life in a minimally invasive way, Edell said.

“It’s getting better as I walk around without oxygen,” Peterson said. He hasn’t had “exacerbations,” where he can’t catch his breath, in a while, and hoped he might get his left lung reduced in time.

“Without these valves, I wouldn’t be here much longer,” Peterson said. “I don’t think I would have made it through the year.”