Illustration symbolizing recovery from emphysema through bronchoscopic lung treatment.

Breathe Easier: Exploring Bronchoscopic Treatments for Emphysema and Air Leaks

Author's portrait.
Nico Varela in Health & Wellness December 2025 • 4 min read.

"Discover how minimally invasive techniques are revolutionizing the management of emphysema and persistent air leaks, offering new hope for improved lung function and quality of life."


For decades, thoracic surgeries have been the standard approach for correcting air leaks and addressing conditions like emphysema. These procedures, while often effective, can be invasive and carry significant risks. However, the last decade has witnessed the rise of bronchoscopic techniques, offering a less invasive alternative to tackle these challenging conditions.

Chronic Obstructive Pulmonary Disease (COPD), a progressive and debilitating illness, significantly impacts millions worldwide. COPD, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is characterized by persistent airflow limitation typically associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases. Lung volume reduction surgeries are employed to alleviate the strain caused by COPD.

Bronchoscopic techniques offer promise in lung volume reduction surgery alongside medical and surgical interventions. These techniques include, but are not limited to, silicone balloons, endobronchial valves, endobronchial coils, Watanabe spigots, biologic therapy, artificial accessory airways and vapor therapy. This article offers a concise overview of these bronchoscopic techniques, with a focus on endobronchial valves and their effectiveness in treating emphysema and persistent air leaks.

What Bronchoscopic Options Are Available for Emphysema and Air Leaks?

Illustration symbolizing recovery from emphysema through bronchoscopic lung treatment.

Several bronchoscopic methods have emerged as potential therapies for lung volume reduction. Each approach has its mechanisms, benefits, and considerations. Here's a brief overview of some key techniques:

These devices, named after their inventor Dr. Watanabe, are bronchial blocking devices made of silicone. They feature a truncated conical shape and lateral studs to anchor to the bronchial wall. Initially designed for broncho-pleural fistulas and persistent pneumothorax, their use has been documented primarily in abstracts with limited patient data. Pneumonia is the most common complication.

  • Silicone Balloons: These were studied on eight patients, showing questionable efficacy, with pneumonia being a common complication.
  • Endobronchial Coils: These nitinol self-actuating devices retract pulmonary parenchyma, reducing volume and restoring lung tissue tension, placed via bronchoscope.
  • Artificial Accessory Airway: This was Suggested in 1978, creating an extra anatomic passage between the emphysematous lung parenchyma and the larger airway [20]. This collateral channel helps to provide a homogenous distribution of the ventilation [14].
  • Biologic Agents: These involves using biologic agents to work as sealant to block off airways, causing atelectasis of that segment and hence reducing lung volume.
  • Thermal Vapor Ablation: This technique involves using a vapor generator to deliver heated water vapor into the bronchial tree [5]. The heated vapor can lead to permanent fibrosis.
Endobronchial valves have been extensively studied among these devices. The basic principles involve deploying a one-way valve into the affected segment. The one-way valve prevents air entry into the airway while allowing air to exit. Initially designed for COPD, these valves are now used for persistent air leaks. Three types of valves are available: Zephyr Valves, IBV Valves, and Miyazawa Valves. Zephyr valves consist of a silicone one-way duckbill valve attached to a nickel-titanium (nitinol) mesh. IBV valves, also known as Spiration umbrellas, comprise of an umbrella-shaped device. Miyazawa Valves (Endo-bronchial Miyazawa Valve, Novatech, La Ciotat France) It is a silicone device, which works like a duckbill mechanism that permits exhalation of air from the distal segments, but at the same time prevents re-inflation.

The Future of Bronchoscopic Interventions

Significant strides have been made in the last fifteen years in developing bronchoscopic solutions for severe emphysema, offering a non-surgical alternative to lung volume reduction. While promising, the field requires ongoing research and large-scale trials to solidify the role and refine the application of these devices. As technology evolves and further studies validate their effectiveness, bronchoscopic interventions may become a cornerstone in treating emphysema and persistent air leaks, providing patients with less invasive options and improved outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What are some of the bronchoscopic options available for treating emphysema and air leaks?

Bronchoscopic techniques for emphysema and air leaks include silicone balloons, endobronchial coils, artificial accessory airways, biologic agents, thermal vapor ablation, Watanabe spigots, and endobronchial valves. Endobronchial valves, such as Zephyr valves, IBV valves, and Miyazawa valves, are particularly notable. These valves are designed to allow air to exit the affected lung segment while preventing air from re-entering. Each method has different mechanisms and considerations, influencing their application in specific cases.

2

Why are endobronchial valves considered an important development in treating emphysema and air leaks?

Endobronchial valves are significant because they offer a minimally invasive approach to lung volume reduction in patients with emphysema and persistent air leaks. These one-way valves, including Zephyr valves, IBV valves, and Miyazawa valves, allow air to escape from damaged lung areas but prevent air from re-entering. This reduces the volume of the hyperinflated lung, improving respiratory mechanics and quality of life. The use of endobronchial valves avoids the risks associated with traditional surgery.

3

What are Watanabe spigots and how are they used in the context of air leaks or emphysema?

Watanabe spigots are bronchial blocking devices made of silicone, designed with a truncated conical shape and lateral studs to anchor to the bronchial wall. Initially intended for broncho-pleural fistulas and persistent pneumothorax, their use has been documented primarily in abstracts with limited patient data. A common complication associated with their use is pneumonia. More data and comprehensive studies are needed to determine its role in treating emphysema and air leaks.

4

What role does lung volume reduction surgery play in treating emphysema, and how do bronchoscopic techniques contribute?

Lung volume reduction surgeries aim to alleviate the strain caused by COPD. This is achieved through various bronchoscopic techniques like the use of silicone balloons, endobronchial valves such as Zephyr valves, IBV valves and Miyazawa Valves, endobronchial coils, Watanabe spigots, biologic therapy, artificial accessory airways, and vapor therapy. These methods reduce the overall volume of the lungs, improving the efficiency of the remaining healthy lung tissue. The goal is to improve breathing and enhance the patient's quality of life.

5

What is COPD, and how does it relate to the bronchoscopic treatments discussed?

COPD, or Chronic Obstructive Pulmonary Disease, is a progressive illness characterized by persistent airflow limitation, typically associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gases. COPD often leads to emphysema and other respiratory complications. Bronchoscopic techniques and interventions aim to improve lung function by reducing lung volume in the most affected regions. The management of COPD involves medical and surgical interventions alongside these bronchoscopic techniques.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.