Bronchoscopic Lung Volume Reduction Techniques

There are two FDA-approved endobronchial valves on the market for bronchoscopic lung volume reduction — the Zephyr® valve and the Spiration® valve. Both valves have been proven effective for patients with severe emphysema. Additional devices are currently being tested as part of clinical trials.

The type of valve chosen is decided on by your medical team. If you do not qualify for BLVR, the Temple Lung Center has other options that may help you breathe easier and improve your quality of life.

About the Zephyr Endobronchial Valve

The Zephyr® Endobronchial Valve was FDA approved in 2018 after it was proven effective by the Temple-led LIBERATE clinical trial.* This tiny device functions as a one-way valve, causing the damaged parts of the lung to deflate and preventing further inflation. The device shrinks the diseased regions of the lung and allows healthier regions to expand and function more efficiently.

The Zephyr® valve was designed with placement functionality in mind. The valve sizing allows for a quick visual assessment of the bronchial diameter, while a depth marker notes the position for the catheter placement. An actuator lever then assists in the action of deploying the valve into the lung.

In the LIBERATE trial, almost half of patients who received the Zephyr® valves had improved lung function, compared with 17% of patients treated with current standard medical management approaches. Patients who responded to the Zephyr® valves were able to breathe easier, increase their exercise capacity and enjoy a better quality of life.

While patients who remained on standard drug therapy did not change or worsen over time, the patients who responded to Zephyr® therapy continued to experience medical benefits 12 months after receiving treatment. Over the long-term, the frequency of adverse events between the two study groups was comparable.

*American Journal of Respiratory and Critical Care Medicine

Zephyr Valve System at a Glance

PURPOSE	FUNCTION	DESIGN	REVERSIBLE?
Designed to significantly improve lung function, exercise capacity and quality of life by reducing the volume of the diseased region that may allow healthier regions to expand and function more efficiently.	Using a flexible bronchoscope, a self-expanding one-way valve is deployed to conform to the bronchial wall, creating an airtight seal. One-way valve prevents airflow into the target lobe. Trapped air and secretions escape through the valves duckbill. Several valves may be placed in the disease lobe.	One-way silicone duckbill valve attached to a nickel-titanium self-expanding retainer, covered in a silicone membrane.	Yes

Zephyr Valve Features

SIZING	POSITIONING	DELIVERY
Multiple sizing with 4 valve sizes ranging from options 4 mm to 8.5 mm.	Prior to valve deployment, a depth marker and sizing feature assists in positioning the catheter for accuracy.	Exact deployment of the valve controlled by an actuator lever.

About the Spiration Valve

The Spiration® valve is a small, umbrella-shaped, one-way valve that is placed inside the airways of the diseased lung which redirects air from diseased parts of the lung to healthier parts. The Spiration® valve’s design allows trapped air and secretions to escape naturally along the airway wall, so that patients may breathe easier.

Spiration® valves are for patients with shortness of breath and hyperinflation associated with severe emphysema.

The Spiration® valve is the first and only endobronchial valve with anchors that prevent migration and expectoration. The anchor allows for more flexibility and more placement options within the lung. The umbrella design of the valve allows for air to move naturally around and through the valve. The Spiration® valve was proven effective in the EMPROVE clinical trial, which showed statistically significant and clinically meaningful improvements in lung function, lung volume reduction, shortness of breath and quality of life.**

Temple was the study’s lead enroller, and Temple Lung Center Director Dr. Gerard Criner was the study’s principal investigator and corresponding author.

**American Journal of Respiratory and Critical Care Medicine

Spiration Valve System at a Glance

PURPOSE	FUNCTION	DESIGN	REVERSIBLE?
Designed to significantly improve the symptoms of emphysema by reducing hyperinflation and improving lung function by redirecting air from the less healthy to the more healthy parts of the lung.	Using a flexible bronchoscope, a self-expanding umbrella-shaped valve deploys and conforms to the bronchial airway. One-way valve prevents airflow into the target lobe. Trapped air and secretions escape naturally along the airway wall. Several valves may be placed in the diseased lobe.	Umbrella-like design comprised of a nitinol frame surrounded by a polymer membrane.	Yes

Spiration Valve Features

SIZING	POSITIONING	VERSATILE ACCESS	MINIMAL TISSUE CONTACT	EASY REMOVAL
Sizing balloon allows provider to select appropriately sized device. Multiple sizing options with 4 valve sizes ranging from 5 mm to 9 mm.	Includes anchors that prevent migration and expectoration.	Anchor design facilitates more flexibility, allowing valve to be placed independent of airway depth or access to a carina.	Unique umbrella design allows natural movement of air and mucus in proximal direction.	Designed to facilitate retrieval with 360-degree access to removal rod.

Page medically reviewed by:
Gerard J. Criner, MD, FACP, FACCP
December 10, 2019