Bronchoscopic Lung Volume Reduction (BLVR)

What is bronchoscopic lung volume reduction (BLVR)?

Bronchoscopic lung volume reduction (BLVR) is a procedure that uses valves to help trapped air get out of your lungs. It can help your lungs work better if you have severe emphysema, a type of COPD (chronic obstructive pulmonary disease). A provider places the valves with a bronchoscope — a tube with a light that goes down your throat and into your lungs.

BLVR is an alternative to lung volume reduction surgery. It’s also called endobronchial valve (EBV) therapy.

It may seem like having more air in your lungs would be a good thing, but when it gets trapped there — like it can with emphysema — it can cause severe symptoms. When there isn’t room in your lungs for any more air, you can’t get a breath, and oxygen can’t get from your lungs to your bloodstream and tissues. This makes you feel tired and short of breath.

The valves release trapped air and prevent more air from getting into damaged parts of your lungs, so oxygen can get to healthy parts of your lungs. Your lungs get smaller and work more efficiently, reducing shortness of breath and tiredness.

BLVR isn’t a cure for emphysema and won’t extend your life. The goal is to help you feel better and improve your quality of life.

Who qualifies for bronchoscopic lung volume reduction?

Providers only recommend BLVR for certain people. You might be eligible if you:

• Are younger than 75.
• Have severe shortness of breath (dyspnea), tiredness and other symptoms, despite appropriate medications and pulmonary rehabilitation.
• Have overinflated lungs and severe air trapping.
• Don’t have collateral ventilation, a condition where air moves through your lungs outside of your airways.
• Don’t currently smoke and haven’t smoked in four months or longer.
• Are able to complete six to 10 weeks of pulmonary rehabilitation before surgery and 10 to 12 sessions after surgery.

How does bronchoscopic lung volume reduction work?

A surgeon will place a bronchoscope down your throat and into your airways. This doesn’t require any incisions (cuts). Your provider will use the bronchoscope to place valves in overinflated areas of your lungs.

Your provider will carefully select where in your lungs (which lobe) to place the valves to prevent complications like a collapsed lung. This usually means placing valves in just one lung, in the area that’s most damaged.

The valves allow air to escape when you breathe out, but they don’t let air into the same area when you breathe in. Over time, this reduces the amount of air trapped in your lungs.

Which tests will I have before BLVR?

You’ll need a full physical exam and several tests to determine if you’re a good candidate for BLVR. These could include:

• Blood tests.
• Chest X-ray.
• High-resolution CT scan.
• Pulmonary function tests.
• Arterial blood gas test.
• Echocardiogram.
• Right heart catheterization.
• Six-minute walk test. This tests your heart and lung function by seeing how far you can walk in six minutes.

How do I prepare for BLVR?

Your provider will give you instructions on how to prepare for valve placement. Following their directions closely can reduce your risk of complications. Before BLVR, your provider may ask you to:

• Not eat anything for eight hours before the procedure (fast).
• Not take certain medications or alter your medication schedule.
• Ask someone to drive you home after a few days in the hospital.

Make sure you tell your provider about all the medications you take, including over-the-counter ones and herbal supplements.

What happens during bronchoscopic lung volume reduction?

During BLVR, a provider will:

1. Give you anesthesia through a vein (IV) that will keep you asleep for the surgery.
2. Insert a bronchoscope into your throat and down into your airways.
3. Place endobronchial valves into your lung. They usually place around four valves.
4. Remove the bronchoscope.

How long does BLVR take?

Endobronchial valve placement takes 30 minutes to an hour.

What happens after BLVR?

A team of healthcare providers will monitor you until you’re awake. You’ll recover in the hospital for several days after the procedure.

What are the advantages of BLVR?

Bronchoscopic lung volume reduction can make a difference in your quality of life by improving your lung function, symptoms and ability to exercise. Compared to surgical procedures to remove part of your lung, the advantages of BLVR include:

• It doesn’t require incisions.
• Recovery time is shorter.
• Endobronchial valves can be removed or replaced if necessary.

What are the risks of BLVR?

While healthcare providers follow procedures to minimize complications, all surgery comes with risks. Complications of BLVR include:

• Reactions to anesthesia.
• Collapsed lung (pneumothorax).
• Pneumonia or other infections.
• COPD exacerbation (flare-up).
• Stroke.
• Bleeding.
• Heart attack (myocardial infarction).
• Arrhythmia (atrial fibrillation).

What is the recovery time for BLVR?

You should expect to stay in the hospital for at least three days after BLVR. You’ll start pulmonary rehabilitation — physical therapy and education that helps you manage your health — within four to six weeks after the procedure.

How successful is bronchoscopic lung volume reduction?

BLVR isn’t a cure for emphysema — success is measured by whether or not your symptoms improve. It can help you feel better and your quality of life may improve.

Symptom relief from BLVR can last two to five years. Your life expectancy (how long you can expect to live) won’t change after BLVR.

How can I take care of myself after BLVR?

Ways you can take care of yourself after BLVR include:

• Follow your provider’s directions on when to rest and when to return to your normal level of activity.
• Attend all of your follow-up appointments with your provider.
• Attend all recommended pulmonary rehabilitation appointments.
• Contact your provider with any questions.

When should I call my healthcare provider?

Call your provider with any questions or concerns before or after BLVR. Go to the emergency room right away if you have signs of an infection, collapsed lung or other serious complications, including:

• Fever.
• Chest pain.
• Severe difficulty breathing.
• Blue skin, lips or nails (cyanosis).

A note from Cleveland Clinic

We don’t yet have a cure for emphysema. But procedures like bronchoscopic lung volume reduction (BLVR) can allow you to breathe easier and get more enjoyment out of life. It might be an option for you if you have severe symptoms and other treatments haven’t helped.

Like any procedure, BLVR has risks and isn’t a good fit for everyone. Talk to your provider about whether endobronchial valves would be a good option for you.