Dermatologic Manifestations of Pulmonary Disease

Combined Zephyr And Spiration Valve Implantation In Severe Pulmonary Emphysema

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The following is a summary of "Efficacy and safety of simultaneous combined Zephyr and Spiration valve therapy in patients with advanced pulmonary emphysema," published in the August 2024 issue of Pulmonology by Dittrich et al.

Endoscopic lung volume reduction using valves represents a minimally invasive approach for managing severe pulmonary emphysema. Among the available options, the Zephyr and Spiration valves are two distinct systems that can be implanted concurrently within the same procedure. This study aimed to evaluate the impact of combined valve therapy on lung function, exercise capacity, and patient-reported outcomes.

Researchers performed a retrospective analysis of 108 patients who underwent simultaneous implantation of Zephyr and Spiration valves. The selection and number of valves implanted were tailored to each patient's anatomical requirements. The effects of the combined treatment on lung function, exercise capacity, and atelectasis formation, along with any associated complications, were assessed at 90 and 180 days post-treatment (90d-FU and 180d-FU).

At the 90-day follow-up (n=90), the mean change in forced expiratory volume in 1 second (FEV1) was 86.7±183.7 mL, and residual volume (RV) showed a mean reduction of -645.3±1276.5 mL, with responder rates of 39.8% and 46.5%, respectively. Complete atelectasis was observed in 16.7% of patients, while partial atelectasis occurred in 25.5%. The six-minute walk test demonstrated an average increase of 27.00 meters (range: -1.50 to 68.50 meters). The incidence of pneumothorax at six months was 10.2%, aligning with rates reported in randomized controlled trials (RCTs). However, due to the inclusion of high-risk patients in this cohort, there was a notably higher incidence of severe COPD exacerbations (21.3%) and pneumonia (12.0%) compared to RCTs.

The simultaneous implantation of Zephyr and Spiration valves yielded significant clinical and functional outcomes improvements, with a manageable risk profile. This combined valve approach holds promise as a viable option for endoscopic lung volume reduction in patients with severe emphysema, potentially enhancing the overall effectiveness of the treatment strategy.

Source: sciencedirect.Com/science/article/abs/pii/S095461112400235X

What Is Emphysema? David Lynch Reveals Impact Of 'many Years Of Smoking'

David Lynch said he is 'paying the price' after smoking for many years. (Michael Kovac/FilmMagic for AFI)

The long-term effects of smoking can be devastating for our health, leading to potentially fatal conditions such as various cancers, heart and lung disease, and stroke.

US filmmaker David Lynch recently revealed how "many years of smoking" have impacted his health. The Twin Peaks director, 78, said he has been diagnosed with emphysema and quit smoking two years ago.

He told film magazine Sight and Sound that he is now "homebound" because the condition makes him vulnerable to catching other diseases like Covid. "It would be very bad for me to get sick, even with a cold," he told the publication (via The Independent).

In a post on X, formerly Twitter, Lynch confirmed to fans that he has emphysema from "my many years of smoking". He added: "I have to say that I enjoyed smoking very much, and I do love tobacco - the smell of it, lighting cigarettes on fire, smoking them - but there is a price to pay for this enjoyment, and the price for me is emphysema.

"I have now quit smoking for over two years. Recently I had many tests and the good news is that I am in excellent shape except for emphysema. I am filled with happiness, and I will never retire."

David Lynch revealed he quite smoking more than two years ago. (Getty Images)

What is emphysema?

Emphysema is a type of lung damage and one of the main conditions of chronic obstructive pulmonary disease (COPD). The other main condition is chronic bronchitis.

People with emphysema experience breathing difficulties as it means the walls of the air sacs in the lungs are damaged. Our lungs consist of millions of tiny air sacs known as alveoli that take in oxygen and expel carbon dioxide.

When these air sacs become damaged, they can break apart and merge into each other, creating holes in the lung. According to Asthma and Lung UK, this can cause breathing difficulties as the damaged part of the lung inflates more and can get in the way of the healthier parts of the lung.

How does smoking lead to emphysema?

Tobacco smoke contains toxins and can cause physical damage to the lungs when they are exposed to it through smoking.

The chemicals and particles released into the lungs can cause irritation, which develop into inflammation and eventually, damage to the alveoli. Long-term exposure to these harmful substances can increase a person's risk of developing COPD.

According to the NHS, smoking is the main cause of COPD and is believed to be responsible for around nine in every 10 cases. However, COPD has also been linked to long-term exposure to harmful fumes or dust, and people who work in dangerous settings may be at higher risk of developing it due to constant exposure to polluted air.

The main symptoms of COPD, including for emphysema, are:

Shortness of breath, particularly when you're active

A persistent chesty cough with phlegm

Frequent chest infections

Persistent wheezing

Symptoms will get progressively worse if not treated. You should see your GP if you experience persistent symptoms of COPD and start treatment as soon as possible, to stop your lungs from becoming even more damaged.

Smoking is thought to be one of the leading causes of COPD. (Getty Images)

Treatment for emphysema

The damage caused by COPD to the lungs is permanent. However, starting treatment as soon as possible can help slow down the progression of the condition.

Treatments include:

Stopping smoking to prevent further damage to the lungs

Inhalers and medicines to help make breathing easier

Pulmonary rehabilitation, which involves a specialised programme of exercise and education

Surgery or lung transplant, but this is only an option for a very small number of people

Asthma and Lung UK adds that people with COPD usually have one or more other long-term health conditions, such as heart disease, diabetes, osteoporosis, muscle and joint problems, anxiety, and depression.

Therefore, it is important to look after other medical conditions to manage COPD and to get all symptoms properly treated.

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Lung Disease

Increasing level of pollution has made breathing in urban areas very difficult, raising the incidence of respiratory problems. Out of the world's top 20 cities with polluted air, 13 belong to India and according to the World health Organisation (WHO) report published in 2011, lung diseases rank 2ndin the list of top 20 causes of death. Naturally, lung disease is a big health issue that needs to be addressed. Here are some facts about lung disease you should know about.

To understand the condition of your lungs, you need to first understand how the lungs function. Lungs are soft organs present on both right and left side of the chest. They are protected by a had covering called the ribcage. Each lung is made of sections called lobes. The main function of the lungs is to make oxygen available for purifying blood and to and eliminate carbondioxide from impure blood or deoxygenated blood. So when you breathe, air travels down your windpipe (trachea). The windpipe bifurcates with each branch entering each of the lungs. Into the lungs, the windpipe is further branched to tubes called bronchioles that end in small sacs called alveoli, where the inhaled air reaches for delivering oxygen.

A lung disease or disorder occurs in the various structures of lungs and disrupts its functioning. It can vary from a mild common cold to life-threatening conditions like pneumonia and cancer. Lung disease can be caused by infections, inflammation, obstruction of airways, decreased lung function, problems related to pulmonary circulation, etc. Smoking, infections, air pollution, genetics, exposure to asbestos, etc. Can cause various lung diseases.

Types

The common as well as rare types of lung disease include -

Causes

'In any form of lung disease mainly the breathing gets affected,' says Dr Animesh Arya, Senior Consultant, Respiratory Medicine, Delhi based Sri Balaji Action Medical Institute. Here are some common forms of lung diseases he explains.

1. Asthma:It is the most common lung disease triggered by allergies, infections and pollutants that harm the airways and cause inflammation.

2. Acute bronchitis: Bronchitis is the inflammation of the air passage. Acute bronchitis is caused by viral or bacterial respiratory infections.

3. Chronic Obstructive Pulmonary Disease (COPD): It a group of diseases that causes breathing difficulties and interfere with the exhalation process of breathing.

4. Chronic bronchitis: It is a type of COPD caused mainly due to smoking.

5. Emphysema: It is a COPD caused by environmental factors and may also be triggered by allergens or organisms that cause diseases like pneumonia and tuberculosis.

Apart from these common forms of lung diseases, other rare lung diseases include:

6. Cystic fibrosis: It is rare lung disease caused by genetic mutation that results in excess mucus production causing blockage of airways.

7. Acute respiratory distress syndrome (ARDS): It is a medical emergency caused as a result of lung injury due to a severe illness.

8. Lung cancer: It can affect any part of the lung. It is mainly caused due to smoking. Here are  10 common symptoms of lung cancer you need to know.

9. Interstitial lung disease: This is a group of diseases affecting the interstitium, a thin lining separating the air sacs.

Symptoms

'Bronchitis, asthma, COPD, lung infections and pulmonary fibrosis have similar symptoms even though they are very different in nature,' says Dr Arya.  He lists a few common symptoms of lung diseases:

Difficulty in breathing

Chronic cough

Being short of breath easily after any strenuous activity

Excess mucus production

Coughing up blood due to inflammation in the lining of the respiratory tract

Chest pain

Air hunger which indicates lack of oxygen and also can cause fatigue

Diagnosis

In most cases, chronic cough, chest pain and breathing difficulties necessitate a lung function test. But your doctor might first take a look at the results of your blood test that may indicate whether you have any kind of lung infection. Otherwise, based on your symptoms your doctor might recommend the following lung function tests for you, as explained by Dr Arya.

Imaging tests: A chest X ray, CT scan or nuclear lung scanning can be done to reveal any kind of structural abnormality of the lungs and the chest. With the help of an Xray, the doctor will be able to detect lung tumors, infections like pneumonia, emphysema, interstitial lung disease. It also helps identification of fluid accumulation around the lungs (pulmonary edema).

Lung Volume measurement or spirometry:  This test will determine how much air your lungs can hold. A device called spirometer is used in the test to record and analyse the volume of air inhaled and exhaled. The test is repeated after administering a bronchodilator which opens up the airways.

Diffusing capacity measurement: This test determines how well oxygen is transferred from the air sacs (alveoli) to the bloodstream.

Maximal Voluntary Ventilation: The maximum capacity a person can breathe is checked in this test.

Lung biopsy: In case interstitial lung disease is suspected, the doctor may suggest a lung biopsy where a tissue from the lung is obtained using procedures like bronchoscopy for investigation.

Treatment

'If any of the above mentioned symptoms persist for a long time, it is better to consult a doctor immediately for diagnosis,' says Dr Arya. The management of lung disease depends on the type of lung disease you're diagnosed with but largely medication is the main treatment option for lung disease patients.

Asthma and COPD patients may require bronchodialtors and inhalers for relieving asthma symptoms and opening up the airways. Read more about medicines for asthma

Expectorants may be prescribed in case of chronic productive cough to loosen the mucus and facilitate easy expulsion

Corticosteroids are given for reducing inflammation and swelling of the lung tissue

Patients with extreme shortness of breath are managed with oxygen therapy, where the prescribed level of oxygen is delivered through a mask

Antibiotics like azithromycin may be prescribed for patients diagnosed with interstitial lung disease. Lung Infections are also treated with antibiotics

There are some thoracic surgical interventions in which the lung volume or contraction and expansion of the diaphragm can be improved for better lung function

Lung transplantation is the last option for patients with end stage lung disease

'However additional measures like lifestyle management are also needed,' says Dr Arya. These measures not only help you protect lung function but also prevent lung disease. Here are some tips he offers for better management and prevention of lung disease.

If you are a smoker, quit smoking and if not, avoid smokers as far as possible.

Identify things that you are allergic to and avoid them. Some common allergens include animal dander, dust, and aerosols.

Contrary to popular belief, exercise helps with lung diseases. Exercising for even half an hour daily can increase your lung capacity.

Manage your weight as being obese puts more stress on your heart and lungs.

 It is important is to take your medication on time every day.

Lastly, get as much rest as possible.

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