Paul Petruccione was doing yard work the day after he came home from Saint Francis Hospital, having undergone a procedure to treat his emphysema and COPD.
That’s after he got up at 4:30 a.m. and cleaned his refrigerator and stove.
His doctor wasn’t thrilled about that, but it was a good sign that Petruccione had gotten through the somewhat risky procedure in good shape.
Petruccione was first diagnosed with emphysema in 2006 — he stopped smoking Marlboro Lights 23 years ago — and then began to suffer from chronic obstructive pulmonary disease.
Ed Stannard/Hartford Courant
Paul Petruccione had valves inserted in his lung to treat his emphysema.
“It had gotten to the point where I was unable to walk 5 feet without stopping to catch my breath. I had to use a walker,” said Petruccione, 74, who lives in Prospect. He was on oxygen full time, too.
None of that is true now.
Petruccione had waited six months after his pulmonologist suggested he look into a procedure that closes off the diseased part of the lung with one-way valves, which let air out but not in, shrinking the segment.
“I wasn’t in a very good place, health-wise,” Petruccione said. “I felt I was nearing the end. My expectations were very, very low. I was reticent to be hospitalized and to be operated on.”
Ed Stannard/Hartford Courant
Dr. Anil Magge of Saint Francis Hospital in Hartford
Finally, he went to see Dr. Anil Magge, an interventional pulmonologist at Saint Francis. “Upon discovering the procedure was noninvasive, that was a big factor in my decision. No one was going to cut me open,” he said.
Magge, who has been at Saint Francis a year, is a specialist in the procedure, known as bronchoscopic lung volume reduction. On March 31, he inserted four Zephyr valves, which look like tiny cages that can collapse into a catheter, into the airways in Petruccione’s left lung’s lower lobe.
He will do the same on the right lung later this year, once it’s clear there is no risk of Petruccione’s left lung collapsing.
According to the American Lung Association, 3 million Americans suffer from emphysema, a severe form of COPD, which affects 12.5 million in the United States.
Courtesy of Pulmonx
The Zephyr valve allows air to leave the disease part of the lung but not to enter it.
The procedure is not a cure, but since Petruccione no longer smokes, there is almost no chance more of his lungs will be affected, Magge said.
“You have to put in a little bit of work,” Petruccione said. “I’m in pulmonary therapy. I have been since last October. I go twice a week. I exercise every day now. My health is good enough to the point where I can … do at least a lap in the pool. I’m no longer on oxygen. No longer using a walker.”
He feels like he’s back to doing “everything that I was able to do prior to getting as sick as I was,” he said. And that’s after undergoing the procedure on just one lung.
There is one limitation: He can’t play golf yet. “That’s a goal,” he said.
Courtesy of Pulmonx
An illustration shows how the Zephyr valve is inserted into an airway into the lung.
A year ago, “you would not recognize what you see today,” Petruccione said. “I was pale, ashen and could barely speak. One of the first things that people noticed after the procedure was phone conversations. I was not breathy talking on the phone. And the other thing that they noticed was my color. I was getting oxygen again, so I wasn’t gray.”
Petruccione was kept in the hospital for three days because there is a 30% risk of a collapsed lung 72 hours after the procedure.
“One of the things that I really love about Dr. Magge is his hands-on approach to everything,” Petruccione said. “He personally came down to my room to take me for a walk around the ward. … Once he saw that I could walk around without oxygen, he was very pleased, as was I.”
However, Magge wasn’t as pleased when he called Petruccione after he was discharged. “He was not happy when I got home and he called to check on me and found out that I was overextending myself.”
Petruccione said he cleaning the refrigerator at 4:30 a.m. because he was too anxious to sleep. “I had all this pent-up energy in me, and I was able to do things I previously could not do,” he said.
Magge said he is conservative with his patients because of the risk of a collapsed lung. “When you put in these valves, you cause a collapse of the bad part of the lungs, the area of the lung that has the most amount of emphysema,” he said. “And the hope is to divert the oxygen to the better parts of the lung.”
As the “bad part” shrinks because of lack of air, “the other part of the lung, the left upper lobe, will try to expand to fill that space,” Magge said. “And when it expands, it can tear, resulting in that pneumothorax (collapsed lung). So that’s why you have to be a little bit cautious when you put in those valves to slowly build up your endurance.”
Magge said Petruccione’s improvement is obvious but it also shows up on breathing tests.
“Quantitatively, he’s also improved,” he said. “His breathing function has doubled, has improved. … We call it dead space but the part of the lung that’s not functioning because of the COPD and emphysema, that’s more than halved.”
Magge inserts the valves using a catheter down the throat and through the trachea into the lung. “You put it into the segment, which is one of the airways of that lobe,” he said. “And it’s a one-way valve. So air can’t go in, but air can come out … so that will help divert all the oxygen to the better parts.”
The procedure is “very easy and straightforward,” Magge said. “It probably took me about 30 minutes to do the procedure. … The hardest part is working up the patient, making sure you’re picking the right patients for it, because you want to have them see the benefit.”
That workup includes blood and breathing tests, a CAT scan and an ultrasound of the heart. The patient also needs to be well enough to be able to breathe through the procedure.
“You want to find the patient’s in their sweet spot, where they’re sick but you can do something about it,” Magge said. “And as I told him, it’s not a cure. We don’t have a cure for COPD and emphysema yet. But we’re making significant progress in treatment.”
Before the valves were introduced, there were two ways to treat emphysema: oxygen and inhalers on one side, surgery on the other. But with surgery, “A lot of patients after the procedure did not do well,” Magge said.
Among the issues were “prolonged hospitalizations … pneumonias, COPD exacerbations, something called a persistent air leak, requiring another surgery and that was a much more invasive process,” he said.
“I feel great,” Petruccione said. “And I’ve wanted to tell as many people as I possibly can about this procedure, because it’s nothing short of a miracle, and I am a living testament to that.”
Ed Stannard can be reached at [email protected].
