Univ. Prof. Dr. med. Felix Herth, Medical Director of the Department for Internal Medicine and Pneumology at Thoraxklinik Heidelberg, is global leader in the field of endoscopic volume reduction for pulmonary diseases. We spoke with him about innovative endoscopic procedures used to treat lung diseases.

Interview

What sets Thoraxklinik Heidelberg apart from other clinics?

Prof. Herth: Thoraxklinik Heidelberg is the oldest lung clinic in Germany and one of the largest throughout Europe. Due to our long expertise in this field we have succeeded in playing a leading role in research and patient care in these areas. One special feature is surely our active interdisciplinary cooperation. This means that all patients are jointly discussed by a round of experts comprising a surgeon, an oncologist, a radiologist, a pathologist and an anesthesiologist in order to ascertain the best treatment option for the individual patient.

How do I know that I have lung disease?

Prof. Herth: There are always the same symptoms: respiratory distress, a cough and sputum - to varying degrees. Unfortunately, these are late symptoms, so that many patients only come for diagnostic tests with advanced stages of the disease.

Thoraxklinik has co-developed new endoscopic procedures to diagnose and treat patients with severe chronic obstructive pulmonary disease (COPD) and emphysema. What is a coil and how does this procedure work?

Prof. Herth:  With pulmonary emphysema, the lungs are too large for the chest due to the emphysema. This means the patient can no longer breathe when exerting himself. This means that patients are only able to walk for a few feet at a time, are not very active physically, and therefore, their condition continues to worsen. By means of endoscopically implanted valves or spirals (coils), the lungs are able to be reduced and thus space is created for more air.

How can this procedure help and how successful has its application been?

Prof. Herth: The objective of an endoscopic lung volume reduction is to improve the overall depth of respiration and to guide the oxygen-rich air to the more functional parts of the lung. Therefore, the selection of the patient, the suitable procedure for this patient, and a realistic assessment and patient education about the possible benefits and possible side effects are of crucial importance to a possible success. With better ventilation, the patient can once again become physically more active.

For which patients is coiling suitable?

Prof. Herth: This procedure is used for COPD disease patients with pulmonary emphysema. The prerequisite is distension of the lungs measured against the lung function, and a so-called target, which is ascertained in special analyses of computer tomography studies of the lung.

Can the patient's health really improve and are there any studies on this?

Prof. Herth: In the meantime, there have been randomized, controlled trials on all procedures, which have examined the value of these procedures. It is clear from all trials that the effect depends on the expertise of the center providing the treatment and the right patient selection. Some 80% of the patients notice a positive effect after the interventions. In particular, resilience and the possibility of engaging in physical exertion are significantly increased.

Bronchoscopy of a patient

What are the risks with surgery?

Prof. Herth: The procedures are all minimally invasive and performed by means of a bronchoscopy. In rare cases, this can lead to pneumothorax or mild bleeding. As a rule, the procedure is tolerated by patients without any problems under short anesthesia.

Another procedure co-developed by you is the bronchial thermoplasty. Could you briefly describe this?

Prof. Herth: Coils and spirals are used for COPD patients. Similar procedures are available for patients with severe asthma, especially “bronchial thermoplasty”. Here the muscle mass surrounding the bronchial tubes is reduced, which leads to an expansion of the bronchial tubes and to improvement in breathing.

Why are these procedures important for patients from abroad?

Prof. Herth: The selection of the patients, for whom this special procedure is a possibility, represents the most important point.  To do this, you need the expertise and a rehearsed team. Thoraxklinik Heidelberg has the most experience in this field worldwide, so that foreign patients also benefit from this expertise when selecting and performing the procedure.

Thank you for this interview.

The questions were asked by Kirsten Gerlach.