Every breath you take

Posted on 13 June 2015

Without realising it, most of us take between 12 and 20 breaths per minute. But what happens when you have chronic obstructive pulmonary disease (COPD) and your lungs can’t function properly? Dr Johan Theron, a pulmonologist at Mediclinic Panorama, explains a revolutionary procedure that offers hope.

Our lungs have tiny sacs called alveoli and when you breathe in, they fill up like balloons. The oxygen in the alveoli is then sent out through your blood stream and the stale air (carbon dioxide) is pushed out when you exhale. When you contract COPD (as in emphysema or chronic bronchitis), the walls between your alveoli break down and your airways fill with mucus. Over time it becomes more and more difficult to breathe out the carbon dioxide, which means your lungs aren’t getting enough fresh oxygen. And so, something as automatic as breathing becomes increasingly difficult as the pulmonary tissue loses its elasticity.

What can you do about breathlessness?
Previously there were few fixes for patients suffering from COPD. Their options included lung transplants, surgery and oxygen therapy. Fortunately that’s changed with the groundbreaking lung volume reduction coil (LVRC) procedure that was first performed at Mediclinic Panorama in September 2014. At the time of going to print, Dr Theron and Professor Coenie Koegelenberg, associate professor in pulmonology at the Department of Internal Medicine at Stellenbosch University, had performed this procedure on three patients. Dr Theron cautions, however, that there are very specific criteria to qualify for this procedure and not everyone will necessarily be suitable.
One of Dr Theron’s patients, Robert Faux (64), had developed severe emphysema. ‘Due to the condition, even basic activities like going to the shops or going to an upstairs level to watch a movie at a shopping centre was too much for me,’ says Robert. ‘Although I stopped smoking eight years ago, it was too late.’
But he didn’t give up and began searching the Internet to find a solution – and that’s when he came across the LVRC procedure. At the time it was only available in Germany, but fortunately Dr Theron was already researching this procedure. Robert booked an appointment and flew from Joburg to Cape Town to meet Dr Theron.

How does it work?
Dr Theron takes us through the LVRC procedure step by step. He adds that there are specific criteria for qualifying for LVRC and it might not suitable for all patients with COPD.

1. The non-invasive LVRC procedure is performed under general anaesthesia in a surgical theatre and takes about 45 minutes to an hour.
2. ‘I use a bronchoscope to get into the lung and then use a measuring device to see what size coil is needed (there are three sizes),’ explains Dr Theron.
3. The coils are inserted into the patient’s airways with a bronchoscope. Because the coils are made from a preformed nitinol ‘memory’ metal, they reform their shape once released from the bronchoscope and gently compress the surrounding diseased lung tissue, giving it increased elasticity. ‘The coils are placed into the airways, and actually fold the lung to make it smaller,’ says Dr Theron. ‘The elasticity of the lungs in emphysema patients is lost – they have “pap” lungs. The coil helps improve the elasticity of the lungs. ’
4. About 10 coils are placed into one lung, either in the upper or lower lobe, depending on which area is more diseased. Only one lung can be done at a time and the patient will need to undergo the procedure again for the other lung a few months after the first one. Most patients experience optimal benefits when both lungs are treated.
5. After all the coils have been placed, the patient is woken up and taken to high care for precautionary measures, then spend a day in hospital before being discharged.

After he had the first lung done, Robert’s recovery was incredible. ‘I came in and was discharged the next morning. Friends expected to find me in bed – instead I was at a braai, drinking spritzers. And I was feeling amazing.’ Robert also noticed that he was able to do at least 50% more exercise than before and his recovery from exercise was three to four times faster. ‘The proof is in the pudding!’ he says.

So What causes COPD?
According to the World Health Organization, more than three million people died of COPD in 2012 – that’s equal to 6% of all deaths globally that year. Fortunately, COPD is preventable. These are the four main causes of COPD:
1. Tobacco smoking is the primary cause of COPD. In fact, Dr Theron says it accounts for about 95% of the cases. Not a smoker? Sadly, second-hand smoke can cause COPD too.
2. Pollution, fumes and dust (occupational and environmental) can also irritate your lungs and lead to COPD.
3. Your genes can also play a role. About three in 100 people who develop COPD have a defect in their DNA. It’s called alpha-1 antitrypsin deficiency, and means your lungs don’t have enough protein to protect them from damage.
4. Asthma can lead to COPD. Although it’s not common, it’s best to treat asthma as early as possible.
Dr Theron says the majority of patients he sees with COPD are smokers. ‘There are a couple of risk factors for developing COPD. In South Africa, smoking, tuberculosis, environmental pollution and occupational exposure are broad contributors to COPD,’ he says. ‘I always tell my patients that they need to stop smoking. And you need to exercise regularly. Even if you think you’re short of breath, you can still exercise.’

There are a number of signs you should be aware of if you’re at risk of developing COPD. These include a cough that lingers, coughing up mucus, any shortness of breath, wheezing, a tight chest, and difficulty with normal activities such as walking up a flight of stairs or vacuuming. When you visit your doctor, you’ll take a breathing test called a spirometry to confirm a diagnosis. You’ll breathe into a spirometer, which measures the capacity of air your lungs can hold and how fast you’re able to empty them. You may undergo a few other tests to rule out asthma or heart failure. These could involve other lung function tests, a chest X-ray or a test that measures the amount of oxygen in your blood. Your doctor will then discuss treatment with you.

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In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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