Endobronchial Valve Treatment - Patient information leaflet

Lung volume reduction with valves

This leaflet is for patients who have undergone a bronchoscopic procedure with valve insertion.

Date of procedure: ………………………………………

The lung is divided into compartments called (lobes) and the valves have been placed in the air ways of one of these lobes.

The valves allow air and secretions to pass out of the lobe and not back in. This may result in the lobe shrinking in volume and may allow more healthy parts of the lung to expand and to help in the exchange of oxygen and carbon dioxide.

After the procedure

You will need to stay in hospital for a least three days after the procedure for observation and to ensure no complications occur.

Risks and possible complications

The most common complications are:

• Pneumothorax – approximately one in 4 people will develop a tear in the lung which causes air to leak into the sac surrounding the lung. However, this usually means the procedure has been successful. These leaks normally heal themselves after treatment with a chest drain. If the tear does not heal itself you may need to have surgery to repair the leak. In rare cases the tear can be a serious/ life threatening complication.
• Chest infection occurs in approximately one in 10 people.
• Bleeding occurs in less than one in 100 people.
• Absence of benefit from treatment.
• Occasionally a valve can become dislodged and coughed out.

Signs and symptoms to report immediately

• Chest pain
• Rapid increased in shortness of breath
• High temperature
• Coughing up blood or more sputum than normal

Follow up plan

For the first few weeks at home you must not put your new valves under too much pressure by over exerting yourself. This means you should take things gently and not to over exercise.

You will be sent home with a course of antibiotics and Prednisolone. You must complete the full course of these as instructed on your discharge summary.

We would also recommend that you continue to take the following to ensure that any sputum you produce is easily coughed out of your lungs:

• Salbutamol inhaler, 2 puffs four times daily through a spacer device, or if you have a nebuliser, use Salbutamol 2.5mg four times daily, whilst you complete the course of antibiotics and steroids
• Carbocisteine 375mg, 2 capsules three times daily to reduce sputum stickiness.

Within in a week of being discharged we will arrange for you to have a chest x-ray at your local hospital. This is to ensure you have not developed a post procedure pneumothorax [collapsed lung], and that the valves have remained in place.

If you have a community respiratory team we will liaise with them and ask them to monitor you for the next couple of weeks. This is the time you are most vulnerable to infections and post procedure complications. If you do not have a local community respiratory team we will ask your GP to review you.

After 2 weeks we will arrange a telephone consultation with a clinical nurse specialist from the Cambridge COPD Centre to discuss your progress and the chest x-ray result. If there are no concerns a further follow up will be arranged 3 months after your valve insertion. At this appointment you will have another chest x-ray, lung function and a face to face consultation.

If you have any concerns in between appointment please contact the COPD clinical nurse specialist team on Direct line: 01223 216647/ mobile 07542 228296.

Should you notice any deterioration in your breathing you MUST seek urgent medical advice locally.

Please show this leaflet to the medical team if you are admitted to hospital or if you need to be seen by your GP post discharge.

Notes for the clinical team

There is a risk of pneumothorax within the first two weeks post procedure – one in 4 patients can develop a small air leak:

Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is sharp and may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue are other symptoms of pneumothorax.

If the patient is compromised they will require urgent review as they may need a chest drain insertion, however as the lung is likely to be tethered a CT scan may be required pre drain insertion – please contact Dr Ravi Mahadeva, Dr Jurgen Herre or the on‑call respiratory specialist registrar via the Addenbrooke’s contact centre for advice on 01223 245151.

The patient needs to be monitored closely for signs of chest infection post hospital discharge and will require prompt treatment to prevent sputum production distal to valve if they do develop signs of an infective exacerbation.

There is normally no contraindication to positive pressure ventilation if this is needed – please discuss with Dr Ravi Mahadeva, Dr Jurgen Herre or the on‑call respiratory specialist registrar via the Addenbrooke’s contact centre on 01223 245151.

Who to contact

Janine Doughty - Lead respiratory clinical nurse specialist or COPD clinical nurse specialist team, Cambridge University Hospitals NHS Foundation Trust

Direct line: 01223 216647 / mobile 07542 228296

References / Sources of evidence

Pulmonx Website

National Institute for Health and Care Excellence Guidance