Advanced Treatments Create New Prospects for Patients and Their Healthcare Providers
New FDA-approved medical treatments can be transformative for patients and families, often providing them with more years to live and an enhanced quality of life.1 Delivering timely, high-quality care to those who need it most is a core mission in healthcare. Everyone benefits when this care improves patient outcomes and supports the sustainability of healthcare systems.
Fortunately, this ideal combination is now improving prospects for individuals with severe emphysema, who face a high risk of mortality and have long suffered from a gap in treatment. 2, 3, 4, 5
A Newer Device Fills Need
Traditionally, the standard of care for severe emphysema has included inhalers and pulmonary rehabilitation, which often leave patients symptomatic. On the more invasive end of the spectrum are lung transplantation and lung volume reduction surgery. Bronchoscopic lung volume reduction (BLVR) is a clinically validated alternative for severe emphysema patients that now exists in the space between medical management and invasive surgery. Severe emphysema patients who remain symptomatic despite optimized medication are eligible for evaluation for this procedure.6
During BLVR, Endobronchial Valves (EBVs), such as Zephyr® Valves – devices about the size of pencil erasers, are bronchoscopically placed in the most diseased part of the lung. There is no cutting involved. The one-way valves release trapped air, often improving lung function, exercise capacity, and quality of life as compared with medical management alone. 7 The procedure is clinically proven, backed by extensive research, and reversible, as the valves can be removed if necessary. 8
EBV benefits are enumerated in the global guidelines for COPD (GOLD)7, and MCG guidelines9, which are used by many payers and hospitals in the US to guide clinically appropriate care, also recognizes BLVR with valves as a treatment option for select advanced emphysema patients.
Evidence of Financial Viability
In addition to the evidence on improved health outcomes, there is now also new evidence regarding the financial sustainability of BLVR programs.
Last year, a team at Beth Israel Deaconess Medical Center (BIDMC), a Boston-based academic center, performed a single-center, retrospective, in-depth study on the question. Eighty-nine patients were referred to the interventional pulmonology clinic at BIDC for BLVR. Of the 89 patients, 37 received valves. While results may vary across hospitals, the analysis determined that BLVR at the medical center delivered quantifiable value in terms of patient referrals, revenue, and contribution margin.10
The study found that 70% of the patients referred to the medical center for BLVR were new to the system. Additionally, 26 of the 89 patients were referred to other specialties at BIDC, including thoracic surgery and pulmonary hypertension clinics, during workup. (These additional subspeciality referrals, e.g., to thoracic surgery and pulmonary hypertension clinics, weren’t included in the financial analysis.)
The study concluded that a BLVR program in a dedicated, specialized center is economically viable and sustainable, attracting referrals from other medical centers and healthcare systems, and generating internal referrals within the medical center.
How Can Providers Engage?
Having proved clinically and financially viable, the procedure should be widely available to more eligible patients. This is becoming the case, but many individuals with severe emphysema are going unrecognized.
Lung-cancer screenings, however, offer an opportunity to detect patients with severe emphysema11 who might benefit from BLVR. The same low-dose CT scans that health systems use to screen for lung cancer can also uncover emphysema.12
Recent studies highlight the prevalence of emphysema in lung cancer screening cohorts, emphasizing the potential for early detection and intervention.
GOLD notes that emphysema is easily detected in chest imaging13, and low-dose CT for lung cancer screening represents a unique opportunity to simultaneously assess patients for unrecognized symptoms of COPD and airflow obstruction. This can uncover new patients that may benefit from treatment with available therapies.
Facilitating Automated Emphysema Detection
Pulmonx’s LungTrax™ Detect platform uses artificial intelligence to facilitate automated patient identification by analyzing CT scan images and identifying the potential presence of emphysema.14 A web portal that secures protected health information (PHI) provides tools to organize and manage potential patient candidates for Zephyr Valve treatment.
In one study, LungTraX Detect found that between 10.5% to 18% of lung cancer screening CT scans had valve-eligible emphysema15, suggesting the need for additional workup. The technology also facilitates the tracking of pulmonary function test (PFT) results, comorbidity, and smoking status, allowing clinical teams to see whether patients meet additional Zephyr Valve treatment criteria.
LungTraX integrates with StratX® Reports14, a cloud-based quantitative CT analysis service that creates graphical reports on a patient’s emphysema destruction, fissure completeness, and lobar volumes. These reports support Zephyr Valve patient selection and treatment targeting.
With these innovative solutions – BLVR with EBVs and streamlined emphysema detection – patients can now access treatments that fill gaps in their care, offering significant clinical and quality-of-life benefits.16
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1 Hartman JE, Klooster K, Slebos DJ. Survival in COPD patients treated with bronchoscopic lung volume reduction. Respir Med. 2022;196:106825. doi:10.1016/j.rmed.2022.106825
2 Wheaton AG, Cunningham TJ, Ford ES, Croft JB. Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64(11):289-295.
3 Mansfield C, Sikirica M, Rousculp M, et al. Patient preferences for endobronchial valve treatment of severe emphysema. Chronic Obstr Pulm Dis (Miami). 2019;6(1):51-60. doi:10.15326/jcopdf.6.1.2018.0157
4 Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000;55(12):1000-1006.
5 Almagro P, Barreiro B, Ochoa de Echagüen A, et al. Finding the best thresholds of FEV1 and dyspnea to predict 5-year survival in COPD patients: the COCOMICS study. PLoS One. 2014;9(2):e89866. doi:10.1371/journal.pone.0089866
6 2025 GOLD REPORT (PDF), Global Initiative for Chronic Obstructive Lung Disease, pp. 104-107.
7 Klooster K, ten Hacken NHT, Hartman JE, Kerstjens HAM, van Rikxoort EM, Slebos DJ. Endobronchial valves for emphysema without interlobar collateral ventilation. N Engl J Med. 2015;373(24):2325-2335. doi:10.1056/NEJMoa1507807
8 Zephyr Valve – Important Safety Information. Pulmonx Corporation. Accessed April 22, 2025. Pulmonx | Zephyr Valve Prescriptive Information
9 MCG Health, Part of the Hearst Health Network. https://www.mcg.com/client-resources/news-item/24th-edition-mcg-care-guidelines/
10 Karambelkar AD, Patel NM, Huang Q, et al. The value of a high-volume bronchoscopic lung volume reduction program for patients with severe emphysema. Chest Pulm. 2023;3(1):100095. doi:10.1016/j.chestp.2022.100095
11 Lynch DA, Moore CM, Wilson C, et al. CT-based visual classification of emphysema: association with mortality in the COPDGene study. Radiology. 2018;288(3):859-866. doi:10.1148/radiol.2018171923
12 Pinsky PF, Gierada DS, Black W, et al. Incidental findings on low-dose CT scan lung cancer screenings and deaths from respiratory diseases. Chest. 2022;161(4):1092-1100. doi:10.1016/j.chest.2021.10.053
13 2025 GOLD REPORT (PDF), Global Initiative for Chronic Obstructive Lung Disease, pp. 45.
14 Pulmonx’s LungTraX Detect CT and StratX Reports help present information from CT scans analyzed by FDA-cleared software (Thirona’s LungQ, K232412) for quantitative assessment of lung structure and function to support clinical decision making, diagnosis and follow-up. LungTrax Detect CT assist healthcare providers with visualizing this LungQ data, which may suggest the presence of emphysema. Refer to Thirona’s indications for use here: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K232412
15 Pulmonx data on file. Valve-eligible emphysema defined as at least one lobe with emphysema destruction of ≥45% at -910HU OR ≥25% at -950HU
16 Klooster K, ten Hacken NHT, Hartman JE, et al. Endobronchial valve therapy in patients with homogeneous emphysema: a randomized clinical trial. N Engl J Med. 2015;373(24):2325-2335. doi:10.1056/NEJMoa1507807
