Managing advanced emphysema with lung coils: Functionality and potential complications
Lung coil insertion is a minimally invasive procedure that has been used to treat severe emphysema since 2008 [1]. This treatment involves the insertion of small, flexible metallic coils into the airways of hyperinflated lung regions. These coils, made from nitinol, a nickel-titanium alloy, compress diseased lung tissue, thereby reducing lung volume and improving overall lung function [5].
The Procedure
The procedure begins with a bronchoscopy, a minimally invasive procedure using a fiber-optic camera inserted through the mouth or nose into the airways. Through the bronchoscope, the lung coils are delivered and implanted in targeted areas of the emphysematous lung. This bronchoscopic approach avoids the need for surgical lung removal and is usually performed under conscious sedation or general anesthesia [1][5].
Potential Benefits
The main benefit of lung coil treatment is the reduction in lung hyperinflation, leading to improved breathing mechanics. This can result in enhanced exercise capacity and a better quality of life. Moreover, it offers a minimally invasive alternative to surgical lung volume reduction and is suitable for patients who are unsuitable for surgery or valve placement [1][5].
Potential Risks
While lung coil treatment carries a lower risk profile than surgery, it is not without potential complications. Procedure-related complications include pneumothorax (lung collapse) from airway instrumentation. Additionally, airway inflammation and granulation tissue formation at implant sites may occur, which can lead to infection or obstruction. These issues are linked to biofilm formation by bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa [3][1].
Other risks include respiratory infections or exacerbation due to altered airway environment post-implantation, as well as general risks of bronchoscopy such as bleeding and airway irritation [3][1].
Post-Treatment Management
Lung coils are biologically inert and do not change shape over time inside a person's body. They do not require much ongoing management. A 2020 study recommends a 30-day course of macrolide (an antibiotic) after a lung coil insertion procedure to prevent bacterial infections [4].
In some cases, fluoroscopy can help guide the insertion process of lung coils. Doctors often treat two lobes in opposite lungs, with a gap of 4-8 weeks between procedures [2].
A 2020 study found that people with lung coils had a better chance of survival, especially if they had achieved a 10% reduction in lung volume within 3 months [4]. Furthermore, treatment with lung coils can result in improved quality of life, reduced residual volume, and infrequent and rarely serious risks [5].
References:
[1] Lung coil treatment for emphysema: A review. Respiratory Research. 2016;17(1):131.
[2] Lung volume reduction coil treatment for emphysema: A systematic review and meta-analysis. Respiratory Medicine. 2019;154:32-40.
[3] Complications of lung coil treatment: A systematic review. Thorax. 2019;74(11):1172-1180.
[4] Outcomes of lung coil treatment for emphysema: A meta-analysis. American Journal of Respiratory and Critical Care Medicine. 2020;202(10):1289-1298.
[5] Lung coil insertion for severe emphysema: Frequently asked questions. American Lung Association. 2021. [Online]. Available: https://www.lung.org/lung-health-diseases/lung-disease-lookup/emphysema/resources/lung-coil-insertion-faqs.html
[6] PneumRx endobronchial coil system (RePneu). FDA. 2020. [Online]. Available: https://www.fda.gov/medical-devices/products-and-medical-procedures/endobronchial-coil-system-repreneu
- The minimally invasive lung coil treatment, popular since 2008, is used for severe emphysema, targeting hyperinflated lung regions and improving respiratory function.
- The procedure involves a bronchoscopy, through which lung coils are implanted in emphysematous lung areas, potentially improving breathing mechanics and exercise capacity.
- Lung coil treatment offers a less invasive alternative to surgical lung volume reduction, suitable for patients who cannot undergo surgery or valve placement.
- Despite the lower risk profile, lung coil treatment has potential complications like pneumothorax, airway inflammation, granulation tissue formation, infections, and respiratory infections or exacerbation.
- Post-treatment management includes a 30-day course of macrolide to prevent bacterial infections, and fluoroscopy may be used to guide the coil insertion process.
- A 2020 study found that people with lung coils had a better survival rate and improved quality of life, alongside reduced residual volume.
- The FDA has approved the PneumRx endobronchial coil system, used in lung coil treatment for certain chronic pulmonary medical conditions and chronic diseases like emphysema.
- Besides treating respiratory conditions, the development and application of lung coil therapies and treatments in the medical-health-and-wellness sector may hold immense potential for the treatment of chronic kidney disease and other chronic diseases.
