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In this article:
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Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure that helps improve breathing for people with severe COPD by reducing trapped air in their lungs.
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BLVR can be an effective treatment for people with COPD who are on maximum medical therapy but still experiencing significant symptoms like breathlessness and wheezing.
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An interventional pulmonologist from Swedish explains how this innovative procedure can alleviate symptoms and improve the quality of life for people facing the challenges of COPD.
COPD relief with bronchoscopic lung volume reduction
Breathing easily is something many of us take for granted. But for people with chronic obstructive pulmonary disease (COPD), struggling for air is a daily occurrence. An innovative treatment called bronchoscopic lung volume reduction (BLVR) could help some of them breathe easier and enjoy a better quality of life.
“BLVR doesn’t replace COPD medications, but for the right patients it can make everyday life feel better – especially patients with COPD who are already on maximal medical therapy but still have terrible symptoms,” says Krupa Solanki, M.D., interventional pulmonologist at Swedish Thoracic Surgery – First Hill. “This procedure could help a lot of people.”
The COPD connection
COPD is a group of lung diseases that make it difficult to breathe and limit the amount of air you can take in. It is one of the leading causes of death in the United States, according to the Centers for Disease Control and Prevention. The two main types of COPD are emphysema and chronic bronchitis. BLVR mainly helps people with emphysema, but many patients have a mix of both types. Both can cause coughing, shortness of breath and wheezing.
In healthy lungs, the airways and air sacs are stretchy and elastic. When you breathe in, your airways supply air to the air sacs, which inflate like small balloons. When you exhale, the air sacs deflate and push out the air.
With COPD, the air sacs and airways lose their ability to stretch. The walls between your air sacs are destroyed over time, and the walls of your airways thicken and become inflamed.
“The small airways deep in the lungs lose elasticity and collapse when you’re breathing out,” explains Dr. Solanki. “Air gets trapped, your lungs overinflate, and your diaphragm flattens out so it can’t move well. Patients feel very short of breath.”
There is no cure for COPD, but lifestyle changes, medication and oxygen therapy may help reduce the symptoms. When traditional treatments no longer offer adequate relief, BLVR could be the answer.
What is bronchoscopic lung volume reduction?
BLVR is a minimally invasive procedure that uses valves to block air from entering more diseased portions of the lung, improving air trapping and your ability to breathe. No incision is needed. The procedure is done under general anesthesia and requires a hospital stay of about three days for monitoring after surgery. The valves can be removed if they don’t improve your symptoms effectively.
“With BLVR, we use a bronchoscope to place tiny one-way valves into the most diseased lobe. That lobe collapses and healthier lobes expand into the space,” says Dr. Solanki. “When that happens, the diaphragm has more room to move, and air is directed to healthier lung tissue that does a better job.”
Benefits and risks of bronchoscopic lung volume reduction
Clinical research shows BLVR can have several potential benefits, including:
- Improved breathing
- Increased exercise tolerance
- Better lung function over the first 6 – 12 months
- Improved ability to perform daily activities
“It hasn’t explicitly been shown to extend life expectancy, but it can greatly improve quality of life,” says Dr. Solanki.
BLVR is a safe, effective treatment for advanced COPD; however, it does have some risks. “The main risk is pneumothorax, or collapsed lung, that can happen when the healthier lobes expand too quickly,” says Dr. Solanki. “Infection is uncommon, but possible.”
A small number of patients don’t notice meaningful symptom relief. Some patients may need a follow-up bronchoscopy to adjust, replace or remove a valve.
Who is eligible for bronchoscopic lung volume reduction?
BLVR is best suited for people with severe COPD who:
- Are on maximal medical therapy, including multiple inhalers and other COPD medications
- Have their COPD reasonably well controlled, without frequent flare-ups or hospitalizations
- Continue to experience significant symptoms, such as breathlessness and wheezing, during basic activities
Before being considered for BLVR, patients must complete screening to determine if the procedure is an option. “From my experience, roughly about half of patients tested meet the criteria and can move forward with treatment,” says Dr. Solanki.
Testing includes:
- Echocardiogram to check heart function
- Pulmonary function tests to measure lung volumes and airflow
- Six-minute walk test to assess exercise tolerance
- Specialized CT scan to evaluate your lungs and help determine which lobe to treat
- Blood gas analysis to measure the amount of carbon dioxide retained in the lungs
Is bronchoscopic lung volume reduction for you?
Although BLVR is not a replacement for other COPD treatments, it can be a good option when your current care plan is no longer effective. Most people notice a gradual improvement in their symptoms in the weeks following their procedure, with noticeable symptom relief occurring within the first 6 – 12 months.
“BLVR is about improving my patients’ quality of life,” says Dr. Solanki. “It’s about helping people walk further, be more active, and live better day-to-day. If you’re on all the right medications but still can’t do what matters, like walk to the mailbox, shop for groceries or enjoy time with your family, BLVR may help you breathe easier.”
Learn more and find a physician or advanced practice clinician (APC)
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Information for patients and visitors
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
