What to know about Zephyr Valve treatment: How it works

According to the COPD Foundation, Zephyr Valves are minimally-invasive devices that can benefit people with severe emphysema. The Food and Drug Administration (FDA) approved their use in 2018.

When a person breathes, air passes through the pharynx and larynx and into the lungs. However, in severe cases of emphysema, individuals experience hyperinflation, as the air becomes trapped in the lungs. This prevents new air from entering the lungs and causes shortness of breath.

A Zephyr Valve can help block off the damaged parts of the lungs that contribute to hyperinflation. It works similarly to a train line system.

It reroutes airflow to the healthy parts of the lungs and allows trapped air and fluids to escape when a person breathes out. This reduces pressure on the diaphragm and improves the individual’s breathing.

Moreover, this device also allows the healthy parts of the lungs to expand and grow, which helps people feel able to take part in exercise and other daily activities.

Individuals receiving a Zephyr Valve will undergo a simple installation procedure that does not involve cuts or incisions. This makes them an alternative treatment to more invasive options, such as lung transplants.

Zephyr Valve treatment is a one-time, in-patient procedure where a specialist inserts the valves into the airways during a bronchoscopy.

If a doctor considers a person a potential candidate for Zephyr Valves, they will issue a referral to a lung specialist. Then, the specialist performs lung function tests to determine whether the treatment is suitable for the individual.

During the procedure

For a Zephyr Valve procedure, a surgeon will:

• give the patient a sleeping medication to make the procedure comfortable and painless
• insert a flexible tube with a tiny fiber-optic camera or a bronchoscope into the lungs from the nose or mouth
• place the Zephyr Valves in the airways using the bronchoscope

The number of valves that lung specialists use depends on the different lung areas that are blocked and contain trapped air, but it is usually around four.

The entire procedure usually lasts around 30–60 minutes.

At the end of the procedure, the specialist removes the bronchoscope and observes the individual during recovery.

After the procedure

The FDA states that the individual may have to remain in the hospital for 3–5 days to recover from the operation. The doctor monitors their progress to minimize any risks that may occur.

They may also prescribe antibiotics or other medications that may assist with any side effects.

If the person does not develop any side effects from the procedure, the hospital provides them with a wallet-sized patient ID card, which states they have the Zephyr implants in their lungs.

It is crucial for individuals to keep this card with them at all times and present it whenever they need medical care, emergencies, or MRI scans.

Additionally, the healthcare team may recommend that the person continue taking the prescription medication, as this may help treat their severe emphysema and minimize the risk of infection.

Afterward, the individual may have to attend follow-up appointments with their doctor to discuss their progress.

The Zephyr Valve treatment is suitable for people with severe cases of emphysema.

Symptoms of the disease include:

• coughing and wheezing
• coughing with mucus
• shortness of breath, from physical activity to typical day-to-day activities
• whistling sounds when breathing
• feeling of tightness in the chest

However, some individuals cannot undergo the Zephyr Valve procedure. These include those who:

• have an active lung infection
• have an allergy to nitinol, nickel, titanium, or silicone
• cannot undergo a bronchoscopy procedure
• have passages in their lungs that bypass the unaffected airways

An individual opting for the Zephyr procedure must also quit smoking at least 4 months before receiving treatment.

People who undergo Zephyr Valve treatment may experience several benefits. These include:

• Reduced shortness of breath: A 2020 study reviewed the effects of Zephyr Valves in people with dyspnea, or shortness of breath. Individuals with severe emphysema reported improvements in breathlessness over 12 months.
• Increased exercise ability: A 2018 study found that 54.9% of participants receiving Zephyr Valve treatment managed to return to work, leisure, and exercise activities that previously affected them.
• Easier long-term breathing: A 2018 review found that individuals with valves implants in their airways to treat emphysema experienced better lung function and exercise capacity. This allows for easier long-term breathing.
• Increased quality of life: Individuals with Zephyr Valves reported improved overall quality of life in four separate randomized controlled clinical trials.

There are risks and side effects of Zephyr Valve treatments to consider. These are more common during the first 45 days after the procedure.

Pneumothorax

Pneumothorax occurs when there is an air leak or tear in the lung, usually during the first 45 days after the procedure.

A randomized controlled study found that 26.6% of study participants developed pneumothorax, the most common serious adverse event during the treatment period.

Another study found that 23.3% of the 43 participants had pneumothorax during the treatment period.

Treatment of pneumothorax depends on the severity. In case of a small air leak, the individual requires oxygen treatment and rest. In more severe cases, a doctor may need to operate on the patient using one of the following methods:

• Needle decompression: The surgeon places a hollow needle in the chest. They attach a syringe to the needle to extract air from the space between the lungs and the chest.
• Tube thoracostomy: A surgeon makes an incision in the chest and places a tube between the lungs and the chest wall to remove excess fluid, blood, or air.

Complex cases of pneumothorax may require removing all the valves.

Pneumonia

Pneumonia is an infection that causes inflammation in the air sacs within the lungs, filling them with fluid or pus.

Symptoms include:

• cough, potentially with mucus
• fever
• sharp chest pain that worsens with deep breathing or coughing.

The risk of pneumonia varies. One study reported a 4.7% risk of the condition from the day of the Zephyr Valve procedure to 45 days later. Additionally, 9% of study participants reported pneumonia as an adverse event from 45 days after the treatment until the 12-month follow-up.

If there is a risk or suspicion of pneumonia, a doctor will perform several tests to confirm the diagnosis. These may include blood tests, an X-ray, a bronchoscopy, or a CT scan.

Treatment for pneumonia includes rest and increased fluid intake, alongside antibiotic, antiviral, or antifungal medications.

Worsening of emphysema or COPD

In the pneumothorax study above, 19.5% of study participants experienced worsening symptoms of COPD during the first 45 days of the procedure, compared to 11.3% of the control group who only received standard treatment.

By the 12-month visit date, 56.6% of the participants had increased COPD or emphysema, compared to 56.5% of the control group.

However, there is limited research describing why the Zephyr Valve can be effective in treating emphysema in some people but may worsen symptoms in others.

Increased shortness of breath

In one study, 16.4% of participants reported dyspnea within 45 days of the procedure.

Another study reported that 2.3% of the 93 participants experienced increased dyspnea within 30 days of the Zephyr Valve treatment.

Death

Impact research reported one death that occurred 12 months after valve implantation.

This study reported 3.1% deaths within 45 days of the procedure and one more participant dying by the 12-month follow-up visit.

Since there is no cure for emphysema to date, individuals with symptoms of this condition may consider different treatments with a doctor.

Alternative treatments include:

• Lifestyle changes: Avoiding or quitting smoking and secondhand smoke may reduce the risk of respiratory conditions. It could also stop existing conditions from exacerbating.
• Oxygen therapy: This may help increase the amount of oxygen in the lungs and the bloodstream.
• Prescribed medication: Medicines, such as bronchodilators, in the form of inhalers can relax the muscles around the airways, allowing individuals to breathe easier.
• Pulmonary rehabilitation: A program for individuals with chronic breathing issues — it may include psychological counseling, exercise, and nutritional help.
• Surgery: In case of severe symptoms of emphysema that do not get better with medication and rehabilitation, a doctor or surgeon may recommend surgery. Procedures include removing damaged lung tissues, removing air spaces that conflict with breathing, or lung transplants. Lung volume reduction surgery and lung transplant are additional alternates for people who may not be suitable candidates for the Zephyr Valve approach.

Zephyr Valves may help individuals with severe emphysema or COPD.

The procedure is noninvasive and allows airflow to reach the healthy parts of the lungs, blocking off the damaged parts from conflicting with incoming air.

The technique may improve a person’s breathing, as the healthy parts of the lungs are able to expand, while blocked air or fluids release over time. Valve therapy reduces shortness of breath, allowing the individual to have a more active lifestyle.

However, doctors may recommend other treatment options for those who cannot receive Zephyr Valve treatment, including medications and pulmonary rehabilitation.