19:14 EST, 12 May 2014
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19:14 EST, 12 May 2014
Richard Kerswill, 53, a retired school caretaker, took part in a trial of the treatment
Thousands
of Britons have breathing difficulties due to emphysema, but a new
procedure could help them. Richard Kerswill, 53, a retired school
caretaker who lives near Aylesbury in Bucks, took part in a trial of the
treatment, as he tells CAROL DAVIS.
THE PATIENT
For my job I used
to walk miles up and down corridors every day. I did it without any
problems, but five years ago I started feeling breathless all the time,
as though there were bricks piled on my chest.
Cold air made it
worse. One October night, I was out with friends and was struggling for
breath. I then just collapsed, which was terrifying. An ambulance took
me to AE where doctors gave me oxygen and an inhaler until I felt
better.
They thought it might have been a panic attack, but my partner, Wendy, and I were puzzled – I’d never had one before.
It
happened several more times over the next five months, always in cold
air – each time, I’d be rushed to hospital by ambulance. I was sent for
X-rays, but no one could work out why it was happening.
Then the next
time I went to AE the consultant ordered a CT (computerised
tomography) scan. This showed I had advanced emphysema – where the tiny
air sacs in your lungs become damaged and the walls between them break
down.
The consultant said emphysema also meant my lungs had become less elastic. This was why breathing was much harder.
He blamed smoking. I was devastated, as I’d given up a few years earlier after a 20-year habit.
I
was given inhalers to help my airways relax so I could breathe more
easily. But it gradually got worse over the next six months. I’d have to
pause for breath while walking, and stay indoors when it was cold. And I
kept getting lung infections.
The school was great, but I had to take early retirement.
I
had regular tests at a specialist hospital – the Royal Brompton in
London – the doctors told me about a trial they were running using a new
device to make the lungs work better so I could breathe more easily.
They’d put tiny metal coils into my lungs, which would compress the diseased areas, so the healthy tissue could work better.
It
sounded amazing. I had the operation in July 2011 at the Chelsea
Westminster Hospital in London – it took only 40 minutes. I was sedated
but awake while the consultant Dr Pallav Shah fed the coils into my
right lung using a flexible tube, which went in through my mouth and
down my throat.
Richard has the lung condition emphysema and had coils implanted in his lungs to help him breathe
I was groggy afterwards, but there was no pain. I stayed in overnight, then just walked to the taxi.
And I couldn’t believe the instant difference – the tightness in my chest had eased so I could go shopping with Wendy.
A month later I had the coils implanted in the left lung, too, and felt even better.
Cold air still affects me, but I’d like to see this offered to many more people, because it could save them a lot of misery.
THE SPECIALIST
Dr
Pallav Shah is consultant physician in respiratory medicine at the
Royal Brompton and Chelsea Westminster Hospitals in London.
About
10 per cent of people over 50 have chronic obstructive pulmonary
disease, or COPD. A common form is emphysema, which affects up to
100,000.
Emphysema is mainly caused by smoking. Other causes include coal pollution.
Instead
of being like a sponge, containing many tiny air sacs, the inflammation
caused by smoking means that the collagen and fibres separating these
air sacs are progressively broken down; causing the sacs to form larger
pockets.
The sacs are where oxygen and carbon dioxide are taken into
the lungs or passed out. But because their surface area is reduced,
stale air becomes trapped, causing the lungs to over-inflate over time.
Airways
in the lungs also become floppy and less elastic, so patients feel they
cannot breathe – and because the larger, stretched lungs put pressure
on the diaphragm, the main breathing muscle, it also becomes less
effective.
This is unpleasant and debilitating, and can become life-threatening.
The
first thing patients should do is stop smoking. We can give them
inhalers containing short-acting or long-acting bronchodilator drugs,
which relax muscles in the lungs and widen airways, and steroids to
reduce inflammation. Special exercises can improve overall fitness to
help them breathe more easily.
Patients with severe emphysema may
also be offered lung volume reduction, to remove damaged parts and allow
the healthy parts to inflate properly.
But this is major surgery with a risk of serious complications including respiratory failure, infection or blood clots.
We
can also use valves to close off the damaged areas of the lung. But
both surgery and valves work when only part of the lung is damaged, and
there are other good areas of healthy lung to compensate.
This applies only to 10 to 15??per cent of patients with emphysema because the damage is usually widespread.
But
now there is a new treatment, devised in the U.S. in 2007. Known as
RePneu lung volume reduction coils, the treatment consists of coils made
of nitinol (an alloy of nickel and titanium which doesn’t corrode) up
to 150??mm long (twice the size of a paperclip).
A sheath initially keeps them straight, but when released, they spring into coils.
Cold air still affects him, but he’d like to see this offered to many more people
When
inside the lungs, the spring gathers up and compresses the diseased
tissue. This tightens the healthy areas, so they can function better –
like pinching the end of a partly deflated balloon to make it firmer.
As we are not removing any tissue, this procedure is suitable for cases of widespread damage.
We have completed the device’s first randomised controlled trial, Reset, and are recruiting for a second.
The
trial has had good results, with most of the 50 patients seeing
significant improvement in exercise capacity, lung function and quality
of life. The procedure carries some risks, including bleeding and risk
of a punctured lung (this happens in 3 to 4??per cent of cases), which
we would then have to re-inflate with a tube into the chest. There is a
0.1??per cent risk of mortality.
The procedure takes 30 to 40 minutes
under sedation. First, we put a local anaesthetic into the throat.
Using X-rays to guide us, we then put a bronchoscope (a telescope that
allows us to visualise the airways) into the lungs, via the mouth and
down the throat.
We then feed ten to 12 coils into the diseased areas
– there are different sized coils, depending on the size of the
patient. They will stay there indefinitely.
We hope this will one
day offer another treatment option which could improve the quality of
life for thousands of patients and possibly help with other lung
conditions, too.
ANY DRAWBACKS?
‘Risks of this procedure include a
collapsed lung, which can happen in patients with COPD anyway – you
then need to put a tube in through the ribs to release trapped air,’
says Anthony De Soyza, senior lecturer at the University of Newcastle
and honorary consultant physician at the Freeman Hospital in Newcastle.
‘There’s
also a small risk of infection from the bronchoscope in the lungs, and a
theoretical risk of damage to blood vessels. But these coils have a
soft end and there is a reduced blood supply to damaged sections of
lungs anyway.
‘Although the Reset trial was small, patients had a
dramatic improvement in their quality of life, and much better than we
achieve with inhalers.’
The procedure is only available on the NHS as
part of the Renew trial at Royal Brompton Hospital and the Chelsea
Westminster, London. Patients can be referred by their GP. To find
out more, visit rbht.nhs.uk/research.
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