Treating severe emphysema with lung coils: How it works and risks

Doctors sometimes recommend lung coils to help someone manage severe emphysema, especially when other treatments have been unsuccessful. Their benefits include increased lung volume, exercise capacity, and quality of life.

Cigarette smoking is the main cause of emphysema. The condition often leads to the destruction of the small air sacs (the alveoli) in the lungs, creating fewer and larger sacs. This change affects the lungs’ ability to exchange gases. Some changes that emphysema causes are irreversible.

Lung coils primarily work to bring back elasticity to the diseased lung tissue of a person with emphysema. By doing so, the lungs can function better, and it reduces hyperinflation risk. Lung hyperinflation occurs when the organ size increases due to trapped air.

Keep reading to learn about lung coils for emphysema, including the procedure to fit one and information about possible risks and the devices’ longer-term management.

Lung coils are medical devices. Manufacturers use nitinol (a nickel-titanium alloy) wire to make the coils. They have shape memory effects and are biologically inert. This means they do not change shape over time inside a person's body or cause a reaction in contact with the body's tissues.

The first lung coils that a doctor inserted in humans was in 2008. The coils come in three sizes — 100 millimeters (mm), 125 mm, and 150 mm — to accommodate the varying airway lengths of different people. The manufacturer provides the necessary equipment (delivery system) with the device to complete the insertion process.

The PneumRx endobronchial coil system (RePneu) is an example of this device.

The underlying theory is that the coils induce lung-tissue compression, resulting in less hyperinflation. At the same time, the coils can improve elastic recoil pressure within the organ, leading to an overall reduction in lung volume.

Less hyperinflation can improve chronic obstructive pulmonary disease (COPD) symptoms — for example, it may reduce shortness of breath and increase exercise capacity.

The coils also work to improve airway resistance in the treated lungs.

All changes induced by the coils allow better functioning of the lungs. For example, a reduced lung volume in people with emphysema can improve the lungs’ ability to stretch and expand. This can further help the diaphragm function better, increasing its pressure on the flow of outward breath.

Further research is necessary to determine how lung coils work, specifically how they can impact the diaphragm or surrounding structures.

Treatment with lung coils is a minimally invasive option. Besides those we mention above, lung coils have the following benefits:

The procedure may require the person to be under general anesthetic.

The exact procedure is complex and may vary according to manufacturers’ guidelines and the doctor performing it.

Generally, the doctor can look inside the lungs using a bronchoscope (a thin, lighted tube with a camera on its end) and place the coils. The doctor typically inserts 10–14 coils in the lung lobe.

Another technique — fluoroscopy — can help guide the process in some cases. Fluoroscopy uses X-rays to produce a video in real time of the lungs.

Doctors also use bronchoscopy, but sometimes they will use bronchoscopy and fluoroscopy.

Doctors tend to treat two lobes in opposite lungs one after the other, with 4–8 weeks between procedures. They work out which lobes to treat using a computed tomography (CT) scan and target the lobes with the most damage.

A hospital stay following the insertion may be necessary.

Some of the more common complications of having lung coils are the following:

Additionally, around 5–10% of people with fitted lung coils may experience a phenomenon known as coil-associated opacity. This noninfectious, localized tissue response can lead to dense areas showing up in lung X-rays.

A 2018 study warns that lung coils for treating emphysema are unsuitable for people with:

To consider if a person is a suitable candidate, experts recommend weighing the benefits of lung coil insertion surgery against the significant risk of disease and death after the procedure.

Another method that can help reduce hyperinflation in the lungs is endobronchial valves. In some cases of advanced emphysema, a pulmonologist may recommend it instead.

Despite the risk of complications, lung coils do not appear to require much ongoing management.

However, a 2020 study reported that some medical centers recommend a 30-day course of macrolide (an antibiotic) after a lung coil insertion procedure. This is to prevent any bacterial infections.

Another 2020 study, which followed participants at least five years after the insertion, concluded that people with lung coils appeared to have a better chance of survival. Specifically, they were likely to survive at least 5 years after the procedure if they had achieved a 10% reduction in lung volume within 3 months.

Lung coils are a medical implant doctors use to treat severe emphysema, and they generally reserve them for people not responding to other medical treatments.

The procedure for inserting the coils may require two sessions, with a doctor treating each lobe of the lung individually. A rest period — usually 4–8 weeks — between the sessions may be necessary.

Experts report significant improvements in quality of life and lung function following the procedure.

However, it also comes with risks of complications. These can include worsening COPD, pneumonia, a collapsed lung, and coil-associated opacity. A doctor can best assess who is a suitable candidate for lung coils insertion.