Imagine not being able to climb a flight of stairs, or being so out of breath that simple tasks such as combing your hair or completing a full sentence is almost impossible.
This is the reality for emphysema sufferers – currently the fourth leading cause of death worldwide according to the World Health Organisation (WHO).
Now, in what's considered a first for Africa, two Cape Town-based doctors at Panorama Mediclinic's Heart and Lung Unit recently performed a revolutionary new procedure called Lung Volume Reduction Coil (LVRC), unleashing a breath of fresh air on the treatment of emphysema patients.
According to the WHO, more than 3 million people died of chronic obstructive pulmonary disease (including emphysema) in 2012 which accounts for approximately 6% of all deaths worldwide.
The leading cause of COPD is smoking. In the South African context tuberculosis and environmental and occupational exposure to pollutants are leading causes of all kinds of obstructive lung disease.
Lung volume reduction coil
Professor Coenie Koegelenberg, associate professor in pulmonology at the Department of Internal Medicine at Stellenbosch University, and Dr Johan Theron, a pulmonologist in private practice at Panorama Mediclinic in Cape Town, performed the LVRC procedure in September 2014.
Traditionally lung reduction procedures to treat emphysema are open surgical procedures whereby severely diseased lung areas are removed to allow the healthier (but often still diseased) lung to function more effectively.
With LVRC this "reduction" in lung volume is done via bronchoscopy.
The first pilot study on the LVRC procedure was done in 2008 in Germany and it has since been performed successfully in other countries in the rest of the world such as the USA, Switzerland, Spain, The Netherlands and France.
Image: Prof Koegelenberg and Dr Theron Credit: Mediclinic
Dr Theron stresses that the most common cause for COPD in South African remains smoking, and often patients suffering from this condition should first and foremost quit the habit to prevent worsening of the already permanent damage. He also urges patients to exercise to maintain lung function.
Theron says that a range of drugs for the treatment of COPD are available and these, along with lifestyle changes, should always be the first line approach.
LVRC is also not available for all COPD sufferers and very strict inclusion criteria is set out to consider patients for the procedure.
Read: Emphysema for 1 in 4 smokers
South Africa's LVRC patient
Mr Rob Faux (64) from Johannesburg suffered from severe emphysema (due to smoking) and was looking for alternative options as the invasive procedures was at not an option for him.
Mr Faux read online about LVRC procedures performed in Germany. He was prepared to travel to Europe for the treatment when he learnt that Dr Theron was doing the procedure in Cape Town. After extensive evaluation and counselling by Dr Theron, Mr Faux underwent his first LVRC procedure on 14 December 2014.
How LVRC Works
“This procedure increases pulmonary (lung) elasticity by inserting a number of tiny coils into the lungs to hold open narrow airways, preventing them from collapsing, decreasing the amount of trapped air and improving the lung’s capacity to contract when breathing out,” explains Dr Theron.
LVRC is a non-invasive procedure (as mentioned, it is done via bronchoscopy), which takes between 30 and 60 minutes to perform, with the patient under general anaesthesia. Patients generally remain in hospital for a day and no specific rehabilitation post-operatively is needed.
See how the coils are placed and how they function:
So far Prof Koegelenberg and Dr Theron have performed six procedures on three patients. There is a small risk of infection, exacerbation of their emphysema and collapse of the lung, but to date, no significant side effects have been recorded.
According to Mr Faux he experienced no side-effects after the procedure. “I had no idea what to expect. Friends took me to hospital and collected me the next day. I felt fine. For my second procedure 6 weeks later, I flew to Cape Town by myself, hired a car, drove to hospital, had the procedure done and flew back to Johannesburg the next day.”
Does it work?
According to Dr Theron the lungs “shrink” back to a smaller size, allowing patients to breathe more easily, almost instantly. “At least three out of four patients will experience a significant improvement.”
Mr Faux confirms: “I felt amazing after my first procedure. Within three days I noted that I was able to do at least 50% more exercise than before. The proof is of course in the pudding. Where ever I went, people said I looked so much better. My colour changed and I look more healthy,” Mr Faux noted.
Will your medical aid pay?
The biggest limiting factor with LVRC is cost. “The coils used in the procedure are imported from Germany and the cost of the LVRC procedure is between R350 000 and R400 000 for two full implants,” said Dr Theron. “While this is quite expensive, the cost is on par with more traditional approaches like surgical (open) lung volume reduction.”
The possible complications with traditional procedures (like prolonged ICU stay due to, for example, pneumonia) are not taken into account.
Mr Faux said his medical aid did not cover any part of the procedure and noted that it is particularly concerning as they do cover the more invasive procedures. Dr Theron confirmed that medical aids don't yet cover the procedure.
Read: 20 claims medical schemes don’t have to pay for
Mr Faux said that medical aids should seriously consider paying for this procedure as it is life changing, non-invasive and has almost no associated complications.
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