Equity First: MetroHealth Offers Patients With Emphysema New Treatment

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The MetroHealth System has successfully performed its first endobronchial valve procedure, bringing the potentially life-changing treatment for emphysema to a population at highest risk for the debilitating disease.

Emphysema, a type of Chronic Obstructive Pulmonary Disease (COPD) caused by smoking, destroys the elasticity in lungs, making them less able to release trapped air, so they become overinflated. When the lungs are overinflated, it becomes difficult to breathe. The one-way endobronchial valve, called the Zephyr valve, is placed in bronchial tubes in the lungs to allow air to escape while preventing more air from becoming trapped. 

The valve is placed during a bronchoscopy, so no incision is required. The procedure itself is considered low risk, but patients are kept in the hospital for three nights to be monitored because of the risk of pneumothorax (when air inside the lungs leaks into the chest cavity), but that risk subsides after the first few days.

Arvind Suguness, MD, and the MetroHealth pulmonology team performed the procedure on their first patient at the end of March. The treatment has been in use since 2018, and Dr. Suguness saw its promise early on. During his fellowship in Washington D.C., he worked with a physician who is a leading expert in the procedure.

Dr. Suguness was impressed with the successful outcomes – patients saw an improvement in their lung function, an increased capacity for exercise and a better overall quality of life. So, when he joined MetroHealth in 2020, he was eager to bring what he'd learned to the patients here. But his plans to begin the Zephyr valve program were put on hold when the pandemic turned the pulmonology team's attention to COVID-19 cases in the ICU.

But now, after a year of planning and collaboration with multiple departments throughout the System, including trauma surgery and anesthesiology, the team is identifying more patients who could benefit from the Zephyr valve therapy and scheduling them for the procedure. To be eligible for valve therapy, patients must meet certain criteria, including agreeing to stop smoking. And that is no small consideration.

The smoking rate is high among MetroHealth's patient population, many of whom are affected by social drivers of health like discrimination and poverty, which the Centers for Disease Control (CDC) have identified as risk factors associated with commercial tobacco use.

According to the CDC Office of Smoking and Health: "For decades, tobacco companies have used promotions, targeted marketing and other tactics to unfairly increase access to and appeal of tobacco products for certain population groups. Discrimination, poverty and other social conditions have also been linked to tobacco product use and can make it harder to quit."

For Dr. Suguness, this explains the urgency to begin this program and offer its benefits to MetroHealth patients.

"A program like this takes a lot of resources to set up. When there are so many other demands on your time, it can be really challenging," he said. “But patients with COPD and emphysema often have few options. Like many people at MetroHealth, I came here because I wanted to serve an underserved population. Being able to breathe is so fundamental to the rest of your life. I thought it was really important to have this option for our patients.”

Donald Bass, who turns 70 this year, was the first patient to receive the Zephyr valve. He said the hardest part of the procedure was quitting smoking. But, he said, the chance to breathe easier was one he couldn't pass up. So, he put down his cigarettes eight months ago. He says he will never pick them up again.

"Dr. Suguness said he knew of a treatment that would help me breathe, but he said, 'You're going to have to quit smoking first'." Donald said. "As every day went by, I thought about everything he said. I really did it for him because I could tell he was so concerned about me. You don't get a lot of doctors like that."

Two weeks after his procedure, Donald enjoyed a walk through Walmart. He was able to leave his oxygen tank in his car while he took time to shop – a pleasure he hasn't had in years. Now, he is hopeful that he might ride his bike again, something Dr. Suguness tells him just may be possible in time.

"A lot of the benefit doesn't happen right away," Dr. Suguness said. "But I think his changes are good."