What Respiratory Therapists Should Know About Minimally Invasive Endobronchial Valve Placement for Lung Reduction Benefit

by John T Murphy, MSOL, RRT, CPFT

According to a citation in the 2020 report for the Global Initiative for Obstructive Lung Disease (GOLD), stable COPD can be treated with a minimally invasive endobronchial valve (EBV) option. There are a few centers that place these as a bronchoscopic interventional therapy and these EBV’s meet criteria as Evidence A. This recommendation means there is a strong recommendation that the clinicians should provide the intervention to eligible patients. Good evidence was found that the intervention improves important health outcomes and concludes that benefits substantially outweigh harm. Generally the EBV placed in the USA are either the Olympus Spiration or Pulmonx Zephyr types.

Disease progression - EBV

At Franciscan Health Indy, workups qualify patients with emphysema to evaluate all inclusion criteria and help to clarify ideal candidates who meet all requirements. EBV placement is receiving the benefit of surgical lung reduction with a minimally invasive procedure. (See inclusion criteria below).

EBV placement inclusion criteria

Other inclusion criteria require prospects to attend 8 Pulmonary Rehabilitation (PR) Phase 2 sessions pre-placement and 20 sessions post-treatment. There is a planned three-day inpatient stay with monitoring and nebulizer therapy as needed. The manufacturer has reported and published great outcomes and benefits from four Randomized clinical trials. Data revealed that up to 1 in 4 patients with valve placement could experience a pneumothorax, so monitoring and vigilance is imperative. Daily chest radiography occurs to evaluate this along with other monitoring. Patient prospects must meet minimal and maximal 6MWT distances as well as rigid PFT criteria and they may not be hypercarbic. BMI’s must be < 35. Other exclusion criteria are shown in the following chart as well as a progression of pictures that illustrate valve placement into the most destructive lobe targeted. Often there are 3 or 4 valves placed with the Zephyr system and if a patient coughs or mobilizes one, it will be removed and another re-placed. Zephyr EBV benefits include many outcomes. (See a list of benefits in the insert below).

For more information on Spiration EBV and especially with reimbursement issues, email them at the following email address, Spirationvalvereim@olympus.com. For information on local availability of Zephyr valve use, email Nurse Practitioner, Abby Ertel, RN NP at abby.ertel@franciscanalliance.org or Ashley Ladd at aladd@pulmonx.com or myself through the ISRC.

These are exciting times for our COPD patients and updates to the 2020 Report of the Global Initiative for Obstructive Pulmonary Disease (GOLD) now list these EBV’s as significant and important. Facilities planning to embark on these services will involve Res-piratory Care, Pulmonary Rehabilitation, and Pulmonary Functions for optimal care plans and program development.

GOLD 2020 Report