Endobronchial Valve Placement

Not being able to take a deep enough breath can be terrifying, for some individuals, oxygen gets trapped in the air sacs, unable to be transferred over to the blood vessels. This results in hyperinflation of the lungs, and it can lead to breathlessness and other serious complications.

What is an Endobronchial Valve?

When we breathe, air flows through our lungs and into the alveoli where the exchange of gases takes place – oxygen from the lungs and carbon dioxide from the blood vessels, and vice versa. However, there are certain diseases such as Chronic Obstructive Pulmonary Disease (COPD) that prevents this smooth exchange from happening. Air gets trapped in the diseased areas of the lungs causing hyperinflation. When this happens, it becomes difficult to breathe as the trapped air prevents new air from being inhaled. 

Endobronchial valves are removable, one-way valves that help to reduce lung hyperinflation by releasing trapped air in the diseased parts of the lungs. By allowing air to be breathed out and preventing air from being breathed in (in the diseased section), it helps the rest of the lung to expand normally, enabling the usual breathing rhythm.  

How does an Endobronchial Valve work?

Endobronchial valves are inserted using the help of a bronchoscope, which is a long, thin tube that has a light and camera attached at one end. They are implanted in such a way that exhaled air can exit the diseased section of the lung when the valves open on exhalation, but inhaled air cannot enter the diseased section of the lung because the valves close on inhalation. 

Placement of endobronchial valves is a minimally invasive procedure that takes approximately 60 minutes.

• An anaesthesia will be administered intravenously to help you relax and remove any discomfort you may feel. 
• A numbing medicine will be sprayed onto the back of your throat.
• Then, the bronchoscope is slowly and gently inserted into your nose or mouth and guided down your trachea (windpipe) and into your lower respiratory tract. 
• When the bronchoscope reaches the diseased section of the lungs, an average of 4 valves will be placed. 
• After the valves are in place, the bronchoscope is slowly guided out of your lungs and mouth.

You may be required to stay in the hospital for a few days for observation and within a few weeks, you should be able to get back to your normal activities.

What happens after placement of Endobronchial Valve in Singapore?

You may feel a bit groggy after the procedure, so you will be monitored for a few hours to ensure that you recover well. A chest x-ray might be performed after the procedure to ensure that no damage was done to your lungs and to ensure that the valves are in place. 

Your throat might still feel numb from the numbing medicine so you will not be allowed to eat or drink until you recover. Your respiratory specialist will advise you on when you may return to your normal activities and diet. 

Who needs Endobronchial Valves placement?

Endobronchial valves are used in individuals with advanced or severe COPD. COPD is the umbrella term for a few lung diseases such as chronic bronchitis and emphysema. With this disease, parts of the respiratory tract are damaged, thereby preventing or restricting the natural process of breathing.

The two main types of COPD are:

• Chronic bronchitis: irritation to the bronchus can result in inflammation and excess production of mucus. When this happens, the bronchial tube becomes narrow, making it difficult for air to pass through. Cilia or the little hair-like structures that line the bronchial tube are usually responsible for moving mucus along. However, cilia can get damaged by bronchitis or tobacco smoke, making them stiff and unable to move, which in turn means that mucus is now stuck in the bronchial tube.
• Emphysema: prolonged exposure to smoke and other irritating gases and particulate matter breaks down the walls of the alveoli. This makes it hard for gaseous exchange to take place between the blood vessels and the alveoli. Individuals with COPD often have both chronic bronchitis and emphysema together and it is a disease that can get progressively worse as time goes on. Endobronchial valves are used to reduce lung hyperinflation which is a symptom of advanced emphysema. 
• Bronchopleural Fistula: are useful in stopping the leakage of the air from the lungs into the pleural space in cases of bronchopleural fistula. Bronchopleural fistula is an abnormal communication that develops between lung and pleural space outside the lung causing lung collapse. These commonly occur in lung cancer patients.

How do I prepare for Endobronchial Valve placement in Singapore?

Before the procedure, you must avoid eating and drinking for 4 hours and you may be required to stop certain medications such as blood thinners and aspirin. Either a sedative or general anaesthesia will be used during the procedure, depending on your preference and advice of your respiratory specialist. 

What are the benefits of Endobronchial Valve placement?

• Improvements in breathing and lung volume
• Increased activity and exercise levels
• Improved quality of life
• Prolonged and healthier life

What are the common possible complications of Endobronchial Valve placement in Singapore?

Placement of endobronchial valves is a minimally invasive procedure, but like all medical procedures, some risks are involved, such as:

• Adverse reaction to anaesthesia
• Pneumothorax (collapsed lungs)
• Infection
• Bleeding
• Pain
• Death (in rare cases)

Frequently asked questions