Endobronchial valve placement is a minimally invasive procedure that helps people with severe emphysema and chronic obstructive pulmonary disease (COPD) to breathe more easily.

COPD is a chronic lung disease that makes is hard for people to breathe. People with COPD can have emphysema or chronic bronchitis, though most have both of these conditions to varying degrees. People with COPD who develop a greater degree of emphysema than chronic bronchitis may benefit from endobronchial valve placement. Those with this type of condition develop breathing difficulties because of excess air that becomes trapped in their lungs. This “hyperinflation” of the lungs makes it harder to take full breaths, because the lungs don’t fully exhale air before another breath is taken.

These breathing difficulties may become even more noticeable with physical exertion. Inhalers and supplemental oxygen can be helpful, but they are sometimes not as effective as people hope they will be, and additional intervention may be necessary. This is where endobronchial valve placement can be helpful. The procedure helps to remove excess air from hyperinflated lungs to expand breathing capacity. It’s typically offered to people with severe emphysema who have quit smoking and who meet other criteria.

Endobronchial valve placement is a minimally invasive procedure that reduces the lung volume of people with COPD who have advanced emphysema. It is a type of bronchoscopic lung volume reduction (BLVR). BLVR refers to several nonsurgical techniques for treating hyperinflation of the lungs due to severe emphysema with the aim of improving breathing. In each of these techniques, doctors insert a bronchoscope—a long, flexible tube equipped with a light, camera—through the nose or mouth and guides it into the lungs. In this way, they can access the lungs without making any incisions. While several BLVR techniques have been developed, endobronchial valve placement is the only one that has been approved by the Food and Drug Administration (FDA).

Endobronchial valve placement is a nonsurgical procedure during which pulmonologists place special one-way valves within airways in the pre-selected lobe of the lungs that are most damaged. During exhalation, the valves open, allowing air and other secretions to escape from the treated lobe. And during inhalation, the valves close, blocking air from entering the treated lobe. Within hours, the treated lobe expectedly collapses, reducing the effects of lung hyperinflation. Once the lung reduces in size, it also reduces pressure on the diaphragm, which helps patient breath better.

These types of valves were first approved by the FDA in 2018.

After an individual is placed under general anesthesia, doctors insert a bronchoscope through the person’s mouth. The bronchoscope is threaded through the windpipe (trachea) and into the airways of the lungs. Three to five endobronchial valves are inserted into pre-designated locations within the affected portion of the lung. The valves completely block selected airways, preventing air from passing through during inhalation. Because the valves are one-way, air or fluids can escape during exhalations. The entire procedure takes between 30 and 60 minutes.

Endobronchial valve placement requires a hospital stay of 3 to 5 days. Patients remain under observation, with daily chest X-rays to ensure that the valves are properly positioned, working properly, and that there are no immediate complications such as lung collapse.

Once the valves are in place, the hyperinflated lung usually shrinks down to a more normal size, which allows lungs to function more optimally. People who have the procedure can catch their breath more easily and exercise for longer periods of time without getting winded. They also report improvement in their overall quality of life.

People with severe emphysema or COPD who have hyperinflated lungs may benefit from endobronchial valve placement. But doctors will determine if this procedure is right for their patients, based on their pre-existing conditions, the location of diseased lung tissue, their overall health, and their smoking status. (It will not be performed on current smokers.)

Endobronchial valve placement is not intended for people with:

• Asthma
• People with chronic lung infections
• People who have had prior lung volume reduction surgery
• People who are actively being treated for cancer

Doctors may sometimes recommend that people with severe emphysema or COPD undergo lung volume reduction surgery, which is performed under general anesthesia and removes diseased portions of the lung to improve overall breathing capacity. It may be effective, but research has shown that there are greater risks associated with that type of surgery. In recent years—and since the minimally invasive endobronchial valve placement has become available—lung volume reduction surgery has become less common.

After endobronchial valves are placed, some people may experience complications such as:

• Lung collapse (pneumothorax)
• Flare-ups of COPD
• Cough
• Pneumonia
• Lung abscess
• Hemoptysis (coughing up blood)

Occasionally, an endobronchial valve may become dislodged or a misplaced valve may be coughed up. The endobronchial valve placement is a reversible procedure, which means if a patient develops a complication that is not responding to treatment, the valves can be removed, either temporarily or permanently, depending on the individual scenario.

People with severe emphysema or COPD who undergo endobronchial valve placement typically have other health conditions, which makes the procedure riskier. Up to 3% of people with severe emphysema who undergo endobronchial valve placement may die after the procedure, due to complications.

“Yale has a comprehensive program to offer endobronchial valve treatment,” says Yale Medicine interventional pulmonologist Sanket Thakore, MD. “Interventional pulmonologists who perform the endobronchial valve procedure work closely with thoracic surgeons and COPD experts at Yale to discuss each patient and weigh all treatment options, such as endobronchial valve placement, surgical lung volume reduction, and lung transplantation.”