ZEPHYR ENDOBRONCHIAL VALVES FOR SEVERE COPD/EMPHYSEMA

What is the Zephyr Valve? 

The Zephyr Valve Treatment is a minimally invasive treatment for people with severe COPD/emphysema. The Zephyr Valves are an implant designed to fit in the airways of the lungs. The valves are placed in selected airways during a bronchoscopy procedure (no incisions or cutting required) and are an alternative to the more invasive traditional lung volume reduction surgery. 

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Who is the Zephyr Valve for? 

Generally, candidates who should be evaluated for Zephyr Valve Treatment are patients who: 
 

• Have a confirmed diagnosis of COPD or emphysema 

• Have to stop to catch their breath often, even with taking their medication as directed 

• Have reduced lung function (FEV1≤50% predicted) with severe hyperinflation (RV>150%)

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These are general criteria but only a Zephyr Valve trained physician can determine if you are a candidate. There is an evaluation process to determine if you are a candidate for the treatment.  Ask your Muir Pulmonologist if you are a candidate.  

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What are the Benefits of Zephyr Valves? 

In clinical studies patients treated with Zephyr Valves have been shown to: 

• Breathe easier.  Many patients notice they can breath easier and do more activities after the procedure.

• Be more active.  You may find it easier to walk, exercise, and do daily tasks.

• Enjoy an improved quality of life.  People often report feeling less short of breath and more confident leaving home. [4-5]

• Reduces air trapping: The valve helps release trapped air, making your lungs work more efficiently.[2-3][6-7]

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Who can get Zephyr valves?
Not everyone with emphysema is a candidate. Doctors use special tests and scans to see if you have the right type of lung damage and if the valves will work for you. The best results are seen in people who do not have "collateral ventilation," which means air does not leak between lung sections.[1][6][8]

 

How does the Procedure Work? 

If you have severe COPD/emphysema you may struggle to catch your breath while doing everyday tasks. This is because the damaged parts of your lungs have lost their ability to release trapped air and have become overinflated. Zephyr Valves are tiny, one-way valves that allow the trapped air to be exhaled from the lungs and prevent more air from becoming trapped there. This helps patients breathe better and do more.

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What can Patients Expect? 

Zephyr Valves are placed during a procedure that does not require any cutting or incisions. A typical Zephyr Valve procedure looks like this: 

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Step 1 – An Anesthesiologist will provide general anesthesia so you will be fully asleep. 

Step 2 – A small tube with a camera, called a bronchoscope, will be inserted into your lungs through your a breathing tube in your mouth. 

Step 3 - At the beginning of the procedure, we perform a Chartis balloon occlusion of the treatment lobe to confirm that it does not receive collateral ventilation from another lobe.  If it does receive collateral ventilation, then the Zephyr valves will not work.  The procedure is aborted at that time, and you will be discharged home.

Step 4 - If the Chartis balloon occlusion confirms that the treatment lobe does NOT receive collateral ventilation from another lobe, then we place Zephyr valves into that treatment lobe.  During the procedure your doctor will place on average 4 Zephyr Valves in the airways. The number of valves placed will depend on the individual anatomy of the patient’s airways and physician discretion. 

Step 5 - You will be monitored closely for 3-4 days to watch for complications.  Some patients who experience a complication may be required to stay longer. 

Step 5 – After the procedure, you will continue to use the medicines that your doctor has prescribed for your condition. 

Step 6 -  Most people notice improvements in breathing and activity within weeks to months.  Regular check-ups are needed to make sure the valves are working and to manage any problems.[1-6]

Step 7 - There is an approximate 20% bronchoscopy revision rate.  Revisions occur if the treatment does not have the desired effect, or if the valves migrate and treatment benefit is lost. Very occasionally despite everything we try, the valves may not work.  If this is the case, we will schedule a bronchoscopy to remove the valves.  The completely reversible nature of this procedure adds to its safety profile.

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What are the risks?
Pneumothorax (collapsed lung): This is the most common serious risk, happening in about 1 in 4 patients, usually within the first few days after the procedure. It may require a hospital stay and treatment.[1-3][5-7]
Valve movement or blockage: Sometimes valves need to be adjusted, replaced, or removed if they move or get blocked.[1][6][9]
Other risks: Rarely, infection, bleeding, or worsening breathing problems can occur. Most people recover well, but close follow-up is important.[1-3][5-6]

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How do I schedule a consultation to see if I am a candidate for the Zephyr Valves? 

Contact Muir Pulmonary Critical Care at (925) 939-3050 to schedule a consultation.

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Where is the Procedure Performed?

Operating Room Location, John Muir Concord, 2540 East Street, Concord, CA 94520

Expect a call from the John Muir Pre-operative team.  Expect to arrive to the hospital 1-2 hours before the scheduled procedure time for check in and pre-operative preparations.

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For more information about the technology, go to https://uspatients.pulmonx.com/  

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References
1. Global Strategy for Prevention, Diagnosis and Management of COPD: 2025 Report.
Alvar Agusti, Bartolome R. Celli, Gerard Criner, et al  Global Initiative for Chronic Obstructive Lung Disease Practice Guideline
2. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE).
Criner GJ, Sue R, Wright S, et al. American Journal of Respiratory and Critical Care Medicine. 2018;198(9):1151-1164. doi:10.1164/rccm.201803-0590OC.
3.A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (TRANSFORM).
Kemp SV, Slebos DJ, Kirk A, et al.American Journal of Respiratory and Critical Care Medicine. 2017;196(12):1535-1543. doi:10.1164/rccm.201707-1327OC.
4.Effect of Zephyr Endobronchial Valves on Dyspnea, Activity Levels, and Quality of Life at One Year. Results From a Randomized Clinical Trial. Dransfield MT, Garner JL, Bhatt SP, et al. Annals of the American Thoracic Society. 2020;17(7):829-838. doi:10.1513/AnnalsATS.201909-666OC.
5. Bronchoscopic Lung Volume Reduction With Endobronchial Zephyr Valves for Severe Emphysema: A Systematic Review and Meta-Analysis. Labarca G, Uribe JP, Pacheco C, et al. Respiration; International Review of Thoracic Diseases. 2019;98(3):268-278. doi:10.1159/000499508.
6. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation. Klooster K, ten Hacken NH, Hartman JE, et al. The New England Journal of Medicine. 2015;373(24):2325-35. doi:10.1056/NEJMoa1507807.
7. Lung Volume Reduction for Emphysema Using One-Way Endobronchial Valves: An Australian Cohort. Sidhu C, Wilsmore N, Shargill N, Rangamuwa K. Medicine. 2023;102(31):e34434. doi:10.1097/MD.0000000000034434.
8. Lung Volume Reduction for Emphysema. Shah PL, Herth FJ, van Geffen WH, Deslee G, Slebos DJ. The Lancet. Respiratory Medicine. 2017;5(2):147-156. doi:10.1016/S2213-2600(16)30221-1.
9. Endobronchial Valve Therapy in Patients With Homogeneous Emphysema. Results From the IMPACT Study. Valipour A, Slebos DJ, Herth F, et al. American Journal of Respiratory and Critical Care Medicine. 2016;194(9):1073-1082. doi:10.1164/rccm.201607-1383OC.