Nerve Zapper That's a Breath of Fresh Air For Lung Disease Patients:
Balloon Treatment Offers New hope for Those Living in Pain > Gasping for Air
- Operation for those with chronic obstructive pulmonary disease (COPD)
- Hour-long procedure works by burning away a patient's damaged nerves
- Signals from nerves make airwaves narrow making patients short of breath
- During procedure electrode placed inside balloon and burns nerves away
Daily Mail UK, 9 July 2016.
Sufferers of severe lung disease are being offered a remarkable new surgical treatment which uses tiny electrodes to burn away nerves that make them feel breathless.
The operation, which is being tested on NHS patients at the Royal Brompton and Chelsea and Westminster Hospitals in London, is the latest hope for those with chronic obstructive pulmonary disease (COPD) – an umbrella term for conditions causing lung damage, including chronic bronchitis and emphysema.
COPD affects many millions throughout the world.
The hour-long procedure works by burning away damaged nerves, and in doing so prevents the abnormal narrowing of the airways and over-production of mucus.
Pictured, how the new treatment works - a catheter with an electrode inside a deflated ‘balloon’ is introduced through a tube and then inflated to hold the electrode in place
In patients with COPD, nerves in the lungs become overactive, often because of damage caused by smoking. Chemical signals from these nerves prompt the airways in the lungs to contract and narrow, so patients feel very short of breath.
The same faulty nerves also make the lungs release much more mucus, so patients can cough and wheeze.
Patients are typically given medication delivered through inhalers which acts against these chemical signals.
These drugs, called bronchodilators, allow the airways to relax and open so the patient can breathe more easily.
But
Dr Pallav Shah, consultant physician at the hospitals taking part in the international clinical trial, called AIRFLOW-1, says: ‘Inhalers only work temporarily, can be distributed irregularly within the lungs, and may cause side effects such as blurred vision and urine retention in a small number of patients.
‘They are also short-acting, and patients may forget to take them.’
The latest procedure uses a device called the dNerva Dual Cooled RF Catheter, which destroys branches of the vagus nerve in the lungs. The nerve is responsible for muscle contraction and mucus secretion.
During the procedure, doctors insert a narrow tube with a light and camera at its tip into the airways under general anaesthetic. A catheter with an electrode inside a deflated ‘balloon’ is introduced through the tube, and then inflated to hold the electrode in place. Radiofrequency energy delivered through the tip destroys the nerve branches
‘It’s rather like tackling an overgrown tree halfway up,’ says Dr Shah. ‘If you can burn away the signals part-way down, far fewer are coming through so the airways are no longer constricting all the time, and less mucus is produced, so patients can breathe more easily.’
Dr Shah has now treated eight patients at the Royal Brompton as part of the international trial. In total, 80 patients have been treated worldwide.
‘So far the results are looking very hopeful, and many patients report that the shortness of breath goes immediately,’ he says.
‘This procedure keeps obstructed airways open to improve breathing, and has the potential to provide a permanent improvement for all patients with COPD.’
Patients still take medication. ‘But if medication gives a ten per cent improvement in symptoms, and we can increase this to an 18 to 20 per cent improvement using this procedure, then in time some patients may be able to give up the medication completely,’ says Dr Shah.
Gillian Joseph, 72, was one of the first patients to take part in the trial. The grandmother-of-five, from Bushey, Hertfordshire, had the hour-long procedure in April after living with emphysema for 18 years. She had smoked for 30 years, but she gave up once she was diagnosed.
Quote:
‘After a few steps I couldn’t walk anywhere or do anything,’ she says. ‘I hated the way I was – I just wanted my life back.
‘But I was noticeably less breathless immediately after having my treatment at the Royal Brompton. Now I can go shopping and walk around normally for the first time in many years.
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Dr Nick Hopkinson, honorary medical adviser to the British Lung Foundation and reader in respiratory medicine at Imperial College London, says:
‘This is a new approach to treating people with COPD, and early data suggests that it could be very helpful. However, we still need larger trials to see how well it works in clinical care.
‘Overactivity of nerves in the airways in people with COPD causes the airways to narrow, making it harder to breathe.
‘Until now, we have been able to reverse this using inhaled medications such as tiotropium, helping to open up the airways.
‘This new approach means that instead of giving medication which block the effects of the nerves, we are destroying the nerves which supply these areas. This has been trialled already in a fairly small number of patients, suggesting that it is fairly safe and early data suggest that it is effective.
‘We now need larger-scale trials to determine how effective it is and how many people it can help, and whether it works best alongside medication to open up the airways or as a standalone treatment making that medication unnecessary.’
END
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