Mike Edwards used to hike, camp and water ski. He played softball and volleyball. He loved to golf.
He would set out on motorcycles with friends, find a spot in the woods and hang up their hammocks to camp out.
But that was before emphysema made breathing so difficult.
“My hobbies kind of went by the wayside,” said Edwards, 58, of Ionia, Michigan. “Now I’d just like to be able to climb the stairs without stopping twice.”
Eager to breathe better, Edwards recently became the first person in Michigan to receive an innovative treatment approved last year for severe emphysema.
Gustavo Cumbo-Nachelli, MD, a Spectrum Health interventional pulmonologist, implanted four Zephyr endobronchial valves in his lung. The one-way valves, about the size of a pencil eraser, block airflow to the diseased area of the lung, while allowing trapped air and fluids to escape. This allows the oxygen inhaled with each breath to reach the healthier parts of the lung.
“We shunt air from less capable areas to areas that are able to handle it a little better,” Dr. Cumbo said.
The endobronchial valves, used in Europe for 10 years, received Food and Drug Administration approval in 2018 for patients with severe emphysema, said Jim Outlaw, a clinical consultant for Pulmonx, the maker of the Zephyr valve.
“There are 3 million people living with severe emphysema in the U.S. It’s the third leading cause of death in this country,” Outlaw said. “The FDA rushed the approval of this because there is such an unmet need.”
Short of breath
Edwards grew up in a family of seven children and worked factory jobs in his younger years. He buffed metal, handled fiberglass and worked with paints and chemicals.
“I seem to have been drawn to the dirty jobs,” he said.
He’s not sure how long he has had emphysema. Doctors diagnosed him in 2008, the same year he quit his 35-year smoking habit and went on disability.
Emphysema is one of the two main types of chronic pulmonary obstructive disorder, known as COPD. It occurs when the tiny air sacs in the lungs, the alveoli, become damaged and enlarged, making it more difficult for lungs to fully expel air, explained John Egan, MD, a Spectrum Health Medical Group interventional pulmonologist.
“Very basically, the problem with emphysema is not getting air in. It’s getting air out—the air gets trapped,” he said.
When they are hyperinflated, the lungs lose their elasticity. A healthy lung functions like an inflated balloon. As soon as it fills with air—unless you block the opening—the air comes rushing out.
With emphysema, “the lungs become more like a plastic bag,” Dr. Egan said. “When you blow air into it, the air just sits there.”
The hyperinflated lungs also flatten the diaphragm, impairing its ability to help the lungs expel air.
Over time, more air becomes trapped in the lungs, making it more difficult to inhale. Even simple activities leave patients short of breath.
“Essentially, it is a very disabling situation,” Dr. Cumbo said. “They cannot take the garbage out or walk the dog or even climb a flight of stairs.”
Like other patients with emphysema, Edwards received the standard treatments—medication, pulmonary rehabilitation and oxygen—to improve his lung function.
He tries to exercise on a treadmill at least three days a week to help boost his lung power.
“You feel like you can do less and less, so you do less and less,” he said. “The only way to combat that is exercise.”
But even with treatment, daily activities are challenging. He becomes breathless just walking up the two flights to his apartment.
A new option
As his condition deteriorated, Edwards sought evaluation for lung reduction surgery, an operation that removes the most diseased part of the lung to improve airflow to the healthier parts. But he was too sick for the operation.
He is also on a lung transplant list, but his condition has not deteriorated enough to move him to the top of the list.
“Some patients with emphysema never reach that point (of lung transplant),” Dr. Cumbo said. “They can live many years before getting worse, feeling very debilitated but without reaching the point where their priority is high enough to get a lung transplant.”
The aim with endobronchial valves is to bridge that gap between medical and surgical treatments, Dr. Cumbo said.
Patients say they are able to breathe easier and are more active after receiving the valves.
In its approval of the Zephyr valves, the FDA cited a study that found 48 percent of the patients who received the valves showed at least 15 percent improved lung function after a year. The valves were granted a “breakthrough device designation” to speed up the development and review of the valves.
One January morning, Edwards underwent the procedure at Spectrum Health Butterworth Hospital.
Using a flexible bronchoscope, Dr. Cumbo identified the most diseased area in the upper part of Edwards’ left lung. He placed four valves to block the flow of air into that section.
Dr. Cumbo will continue to follow Edwards and monitor his lung function, looking for improvements over the next year.
A few weeks after the procedure, Edwards said he noticed his treadmill routine was a little bit easier. His heart rate used to run around 117 beats per minute. Now with the same exercise, it stayed below 107.
“I think the lungs are working better so my heart doesn’t have to work so hard,” he said.
If he has his way, Edwards will swing a club on the golf course again someday. And he hopes he won’t need to bring his portable oxygen unit with him every time he leaves home.
“Michael has been struggling to breathe for a while now,” Dr. Cumbo said. “If everything works well, we will give him back some of that breathing that means so much.”