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Clinical Research News

Emphysema Research

Columbia's Center for Chest Disease tests new devices to treat advanced emphysema.

Deployment of the one-way Emphasys Endobronchial Valve™ in a blocked airway.
Deployment of the one-way Emphasys Endobronchial Valve in a blocked airway.

Emphysema and Genetics

As is the case with lung cancer, the highest risk for emphysema results from heavy smoking. Of all patients who smoke heavily, only some develop emphysema, and genetic researchers believe that genes are likely involved in determining why some develop the disease and some do not. Research is currently underway to identify which genes may play a role in predisposing people to the disease. About one out of 50 people with emphysema has an inherited disorder called Alpha-1 antitrypsin deficiency. In these patients, replacement of the insufficient protein, Alpha-1 antitrypsin, can be achieved through medical therapy. This can prevent the development of emphysema, liver disease, and other problems in people with this inherited condition.

Emphysema occurs when the small air sacs of the lung break down. The collapse of these sacs leads to trapped gas and hyperinflation (overfilling of the chest with air). Breathing becomes increasingly difficult, causing shortness of breath, fatigue, and diminished exercise capacity.

Lung Volume Reduction Surgery (LVRS) is the gold standard in treating advanced emphysema, and in addition to oxygen therapy, the only treatment shown to prolong survival. By removing the damaged portions of lung tissue, the procedure enables the remaining lung tissue to function more effectively. After the procedure, patients experience an increase in ability to exercise, improved survival, and an overall improvement in quality of life.

NewYork-Presbyterian Hospital/Columbia University Medical Center has been a leader in LVRS since 1994, with success rates of over 90%. In most cases, surgeons at the center perform LVRS using video-assisted thoracoscopic techniques through minimally invasive incisions. The procedure is very safe and effective, with no procedure-related deaths occurring at the center in over twelve years.

To expand treatment options for more patients, the Center for Chest Disease is currently investigating two devices that could achieve LVRS-like results without surgery. The investigational devices are inserted through the windpipe into the lungs, and these devices are currently in late clinical trials. The lead investigators are Mark E. Ginsburg, MD, Surgical Director of the LeBuhn Center for Chest Disease and Respiratory Failure at NewYork-Presbyterian Hospital/Columbia University Medical Center, and Roger Maxfield, MD, Associate Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons.

Investigational Devices

  • Exhale Airway Stents for Emphysema (EASE): this trial is testing the safety and effectiveness of implanting a tiny drug eluting stent to keep the airway open. Placement of up to six stents (wire mesh devices smaller than the size of a pencil eraser) is performed through a bronchoscope inserted through the mouth. Once placed, the stents create new pathways for the air to flow, bypassing the damaged lung tissue.
  • Endobronchial Valve for Emphysema Palliation Trial (VENT): this multicenter trial is testing an implantable, one-way valve called Emphasys Endobronchial Valve (EBV). The valve is designed to redirect airflow to healthier lung tissue by blocking inhaled air to the diseased lung tissue. EBV is most appropriate for a subset of patients with hyperinflation of the lungs and severe emphysema, according to Dr. Ginsburg.

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