A treatment for emphysema and COPD is becoming more widely available, and Deborah Stahlnecker, DO, at St. Luke’s University Hospital in Bethlehem, Pennsylvania, is one of only a few pulmonologists providing it. The DO interviewed Dr. Stahlnecker about the Zephyr endobronchial valve and how this pencil-eraser-shaped device helps patients breathe easier in most cases.
This device, which operates like a relief valve, is inserted without surgery or incisions into damaged areas of the lung to help air to escape. Dr. Stahlnecker has no financial disclosures to report related to this device.
What kind of patient would be a good candidate for this treatment option?
One of the common diseases I see in the field of pulmonary medicine are patients with COPD and emphysema. This procedure is meant for patients who have advanced emphysema who continue to struggle with symptoms, despite taking their inhalers, using oxygen and doing pulmonary rehab. This is another option to help those patients improve their lung capacity and their quality of life in relationship to their COPD.
Since you started offering this at St. Luke’s, how many of these procedures have you done?
We got our program off the ground in February 2020. This procedure mandates the patient stays in the hospital for three nights. In March, COVID came. We got shut down because we couldn’t bring sick patients into the hospital and expose them to the potential of getting COVID.
Since we got back up and running about six months ago, we have fully treated five patients. We’re starting to ramp up and perform more evaluations now that people are starting to feel comfortable with hospital stays and more people are getting vaccinated.
Most of the patients we have treated have been quite successful. I had a patient come to me last week and tell me he has not breathed this easy in a year and a half. He’s doing some things he wasn’t able to do before. It’s pretty awesome that we’re able to help our patients when, traditionally, once patients have advanced COPD, they’re looking at something like a lung transplant. Most patients are either not interested in a transplant or wouldn’t qualify.
The Zephyr endobronchial valve has only been commercially available for about three years. It’s still a relatively new procedure in the U.S. It is minimally invasive. We implant these small one-way valves into the most damaged part of the lungs, and this allows air escape that part of the lung and not go back in. As a result, the “healthier” parts of the lung can do the work. I use healthier in quotes because COPD usually affects both lungs top to bottom, but in varying degrees. That’s really how and why the valves work for the right patient.
Some doctors describe this procedure as a more efficient, better way to do a procedure that you’ve been doing for years. Is that accurate?
Sure. In the mid to late ’90s, they started doing surgical lung volume reduction. That entails removing the upper portion of both lungs, so that achieves the same result—removing the damaged part of the lung so the healthier parts function more freely, allowing the diaphragm to function more appropriately.
With the advent of that procedure, researchers and doctors began to ask, “How can we achieve the same benefit but in a less invasive way?” That’s really how this was born, the idea of lung volume reduction. But in a much easier way for patients and physicians.
You probably saw this coming by reading the research when it was in development. How did you get ahead of it and make sure your hospital would offer it?
It’s kind of funny how this all transpired. In my fellowship, I was very procedure oriented. When I graduated fellowship, there wasn’t as much opportunity to pursue a true interventional pulmonary fellowship track; it was really in its infancy.
But I always held on to really being fascinated by the interventional pulmonary side of my field. So I kept up with different things that have been experimental. There are some things that we followed and didn’t end up panning out. But this is definitely one that has.
I was very fortunate to be able to collaborate with Dr. Gerard Criner at the Temple Lung Center, who has probably done most or nearly most of these cases in the U.S. He really served as a mentor and helped us get the program here at St. Luke’s. I was able to spend some time with him very shortly after the valves became commercially available in the U.S.
It’s definitely something we’ve been watching and excited about, and St. Luke’s has been so supportive of getting the program up and running.
Are the cost savings with this procedure as opposed to invasive surgery significant?
I don’t know what the cost of a surgical lung volume reduction is, but certainly if you’re looking at the cost of a lung transplant, you’re talking six digits plus. Even though this is minimally invasive, it is still a three-day hospital stay.
You’re still incurring some costs with a hospitalization because you need to monitor patients for some of the potential complications, notably pneumothorax. That can occur after the treatment as the lung sort of shifts in the chest. But it’s certainly going to be less expensive than surgical lung volume reduction and far less expensive than a transplant.
How much work went into the implementation of this treatment option?
It takes a lot of infrastructure, planning, vigilance and attention to detail. It’s a lot of work, but it’s worth it. It takes the right physician and the right team. I can’t do this myself. I have respiratory therapists, coordinators and other staff who have been phenomenal and accommodating to us. It took about a year of planning just to be able to treat our first patient, so certainly, there’s no easy button.
You mentioned one of your patients who came back and reported on how well he was doing. What can you tell me about your very first patient who got this procedure?
He was my most excited patient. Unfortunately, his COPD is so bad throughout both lungs that he did not gain the outcome that we had all hoped for. If you look, there are probably about a quarter of the patients who end up getting these that aren’t the home run like the fella I just treated a month and a half ago. He was a home run. My very first patient was not. And that’s OK. We work through it.
We’re very honest with the patients when it comes to what they can expect and the work it’s going to take for them and for me. So unfortunately, the very first one wasn’t our star patient. But he’s still very grateful we tried, because these folks really don’t have a lot of other options to try and live easier with their lungs.
Why did you choose osteopathic medicine?
I knew I wanted to be a doctor ever since I was 13. Truth be told, I did look at both the DO and the MD worlds. But I still remember the day I interviewed at PCOM and thought, “This is where I need to be.” I was drawn to the whole-person view of medicine and treating patients, and the training there was superb.