A LOOK AT INTERVENTIONAL PULMONOLOGY: BRINGING CLINICAL PRACTICE AND RESEARCH TOGETHER
At MQ Health, our physicians in interventional pulmonology are at the forefront of their field and actively engaged in research. We look at how their academic expertise is leading to better patient outcomes.
Macquarie University Hospital is the first centre in the world to perform innovative electroporation therapy for patients with COPD with predominantly chronic bronchitis.
Patients with severe chronic obstructive pulmonary disease (COPD) and predominant chronic bronchitis tend to have excess amounts of sputum, which can worsen airway obstruction leading to an increased risk of infection and exacerbations.
Respiratory physicians at Macquarie University Hospital have completed the first in-human treatment of a new interventional technique – electroporation therapy – that reduces the cells causing the sputum.
The approach uses the delivery of electrical energy to bronchial airways, with the first two cases performed by Professor Alvin Ing, Dr Jonathan Williamson and Dr Tajalli Saghaie, interventional pulmonologists at Macquarie University Hospital.
Macquarie University Hospital – established to bring new and innovative technologies to patients – worked in collaboration with Gala Therapeutics, who developed the unique initial concept and has seen it to fruition.
Good news for asthma sufferers as research shows the safety and effectiveness of bronchial thermoplasty.
In 2014, Macquarie University Hospital respiratory physicians were the first in New South Wales to perform bronchial thermoplasty for the treatment of severe asthma. To date, more than 25 people have undergone the procedure, with the first analysis of clinical results just published.
A team of respiratory physicians, including those at Macquarie University Hospital, evaluated the safety and effectiveness of the procedure in 20 clinical cases over an 18-month period. This was a prospective analysis of Australia’s first data.
The research was published in the Internal Medicine Journal by Professor Alvin Ing and colleagues in May this year. It shows that for appropriate patients – those with severe asthma – the benefits are significant.
“What we saw in the data was an overall significant reduction in symptoms at six months, including a reduction of severe exacerbations with Emergency Department visits,” explained Professor Ing.
“The use of medication decreased significantly, especially in patients on maintenance oral corticosteroids with 50 per cent of patients able to cease oral steroids after the procedure. Lung function also improved in patients whose baseline lung function was below 60 per cent and, as expected, quality of life improved overall.
“This early data shows that bronchial thermoplasty is a safe procedure, which can achieve clinical improvement in those with uncontrolled symptoms and severe airflow obstruction. Our data collection is ongoing as part of long-term research in this area.”
Improving COPD Patient Selection for Endobronchial Valves
Chronic obstructive pulmonary disease (COPD), which includes patients with chronic bronchitis and emphysema, remains common in Australia, as high smoking rates from the 1960s and 70s continue to take their toll. In Australians over the age of 75, approximately 30 per cent will have COPD. For this demographic, the rate of Emergency Department visits is high.
In addition to destroying lung tissue, COPD causes hyperinflation and gas trapping in the diseased lung, further impairing breathing mechanics.
For the past decade, COPD patients have had a minimally invasive procedure available to them: insertion of one-way endobronchial valves that functions to decrease the volume diseased, hyper-inflated lung and simultaneously allow more air and blood flow to the more normal lung, improving its function.
However, the results are not always consistent, with the risk of air cross-ventilating between different parts of the lungs causing the procedure to fail in some patients. Incomplete fissures that separate lobes of the lung result in this problem.
Macquarie University Hospital physician Dr Jonathan Williamson, building on the work of European studies, has developed at the Hospital methods to better assess candidates for endobronchial valve therapy. His approach is based on the type of emphysema and the objective assessment of fissures.
“We know from the clinical data that patients with high heterogeneity (upper lobe or lower predominant) emphysema did better than those with low heterogeneity,” said Dr Williamson.
“Patients with lung fissures intact, and hence lobes anatomically isolated, also did better because this predicted an absence of cross-ventilating between lung lobes.”
Researchers then developed the Chartis assessment as a predictive procedure. The technique uses a balloon with catheter to anatomically isolate the lobe and detect any cross-ventilation flow between lobes that may be present.
“We now screen patients through both fissure analysis with high-resolution CT scanning and Chartis,” said Dr Williamson. “This way, we don’t put patients through a procedure that we know won’t work for them. Clinical data is allowing us to work out better who benefits from these valves.”
The endobronchial valve procedure has been performed at Macquarie University Hospital since 2010. The Hospital is the leading centre in New South Wales performing this procedure, and has the only Interventional Pulmonology Multidisciplinary Meeting in NSW where all patients being put forward for this and other procedures are discussed and managed.