The present invention is generally directed to a removable anchored device, system, and method for treating Chronic Obstructive Pulmonary Disease (COPD). The present invention is more particularly directed to providing an anchored intra-bronchial obstruction that may be removable.
COPD has become a major cause of morbidity and mortality in the United States over the last three decades. COPD is characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. The airflow obstruction in COPD is due largely to structural abnormalities in the smaller airways. Important causes are inflammation, fibrosis, goblet cell metaplasia, and smooth muscle hypertrophy in terminal bronchioles.
The incidence, prevalence, and health-related costs of COPD are on the rise. Mortality due to COPD is also on the rise. In 1991, COPD was the fourth leading cause of death in the United States and had increased 33% since 1979. COPD affects the patient's whole life, producing increasing disability. It has three main symptoms: cough; breathlessness; and wheeze. At first, breathlessness may be noticed when running for a bus, digging in the garden, or walking uphill. Later, it may be noticed when simply walking in the kitchen. Over time, it may occur with less and less effort until it is present all of the time. COPD is a progressive disease and currently has no cure. Current treatments for COPD include the prevention of further respiratory damage, pharmacotherapy, and surgery. Each is discussed below.
The prevention of further respiratory damage entails the adoption of a healthy lifestyle. Smoking cessation is believed to be the single most important therapeutic intervention. However, regular exercise and weight control are also important. Patients whose symptoms restrict their daily activities or who otherwise have an impaired quality of life may require a pulmonary rehabilitation program including ventilatory muscle training and breathing retraining. Long-term oxygen therapy may also become necessary.
Pharmacotherapy may include bronchodilator therapy to open up the airways as much as possible or inhaled beta-agonists. For those patients who respond poorly to the foregoing or who have persistent symptoms, ipratropium bromide may be indicated. Further, courses of steroids, such as corticosteroids, may be required. Lastly, antibiotics may be required to prevent infections and influenza and pneumococcal vaccines may be routinely administered. Unfortunately, there is no evidence that early, regular use of pharmacotherapy will alter the progression of COPD.
About 40 years ago, it was first postulated that the tethering force that tends to keep the intratharacic airways open was lost in emphysema and that by surgically removing the most affected parts of the lungs, the force could be partially restored. Although the surgery was deemed promising, the lung volume reduction surgery (LVRS) procedure was abandoned. LVRS was later revived. In the early 1990's, hundreds of patients underwent the procedure. However, the number of procedures declined because Medicare stopping reimbursing for LVRS. The procedure is currently under review in controlled clinical trials. However, preliminary data indicates that patients benefit from the procedure in terms of an increase in forced expiratory volume, a decrease in total lung capacity, and a significant improvement in lung function, dyspnea, and quality of life. Improvements in pulmonary function after LVRS have been attributed to at least four possible mechanisms; enhanced elastic lung recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricular filling.
Lastly, lung transplantation is also a therapeutic option. Today, COPD is the most common diagnosis for which lung transplantation is considered. Unfortunately, this consideration is given for only those with advanced COPD. Given the limited availability of donor organs, lung transplant is far from being available to all patients.
There is a need for additional non-surgical options for permanently treating COPD without surgery. A promising new therapy includes non-surgical apparatus and procedures for lung volume reduction by permanently obstructing the air passageway that communicates with the portion of the lung to be collapsed. The therapy includes placing an obstruction in the air passageway that prevents inhaled air from flowing into the portion of the lung to be collapsed. This provides lung volume reduction with concomitant improved pulmonary function without the need for surgery. The effectiveness of obstructions may be enhanced if it is anchored in place. The effectiveness may also be enhanced if the obstruction is removable. However, no readily available apparatus and method exists for anchoring the obstruction, and for removal if required.
In view of the foregoing, there is a need in the art for a new and improved apparatus and method for permanently obstructing an air passageway that is anchored in place, and that may be removed if required. The present invention is directed to a device, system, and method that provide such an improved apparatus and method for treating COPD.
The present invention provides an intra-bronchial device for placement in an air passageway of a patient to collapse a lung portion associated with the air passageway. The device includes an obstructing member that prevents air from being inhaled into the lung portion to collapse the lung portion, and an anchoring device that anchors the obstructing member in the air passageway by engaging the obstructing member and the air passageway wall. The anchoring device may frictionally engage the obstructing member. The engagement provided by the anchoring device may be releasable for removal of the obstructing member. The anchoring device may comprise a material having a memory of an original undistorted shape, and a resiliency to return the material from a distorted shape to the original undistorted shape. The anchoring device may be balloon expandable from a first shape to a second shape that engages the obstructing member and the air passageway. The obstructing member may be a one-way valve.
An alternative embodiment of the present invention provides an intra-bronchial device for placement in an air passageway of a patient to collapse a lung portion associated with the air passageway. The device includes an obstructing member that prevents air from being inhaled into the lung portion to collapse the lung portion, and an anchoring device having a projection that anchors the obstructing member in the air passageway by piercingly engaging the obstructing member and the air passageway wall. The engagement provided by the anchoring device may be releasable for removal of the obstructing member. The anchoring device may comprise a material having a memory of an original undistorted shape, and a resiliency to return the material from a distorted shape to the original undistorted shape. The anchoring device may be balloon expandable from a compressed shape to a deployed shape that engages the obstructing member and the air passageway wall. The anchoring device may be configured to urge engagement with the air passageway wall. The projection may be releasable from the air passageway wall for removal of the anchoring device. The projection may include a stop dimensioned to limit the piercing. At least a portion of the anchoring device may be collapsible for placement in the air passageway. The anchoring device may collapse centrally. The anchoring device may include a projection that collapses centrally. The anchoring device may be configured to move from a first position to a second position to anchor the obstructing member in the air passageway. The anchoring device may be configured to move from a first position to a second position to anchor the obstructing member in the air passageway, and to move from the second position to the first position to disengage the obstructing member for removal from the air passageway. The obstructing member may be a one-way valve.
Another alternative embodiment provides a method of reducing the size of a lung by collapsing a portion of the lung. The method includes the step of providing an intra-bronchial device having an obstructing member which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and an anchoring device that anchors the obstructing member in the air passageway by engaging the obstructing member and the wall of the air passageway. The method also includes the steps of placing the obstructing member in the air passageway, placing the anchoring device in the air passageway, and deploying the anchoring device. The anchoring device may include a projection that piercingly engages the obstructing member and the air 3 passageway wall. The anchoring device may be releasable for removal of the intra-bronchial device. The obstructing member may form a one-way valve. At least a portion of the anchoring device may be collapsible.
A further embodiment provides a method of reducing the size of a lung by collapsing a portion of the lung. The method includes the step of providing an intra-bronchial device having an obstructing member which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and an anchoring device that anchors the obstructing member in the air passageway by engaging the obstructing member and the wall of the air passageway. The method also includes the steps of placing the obstructing member in the air passageway, placing the anchoring device in the air passageway, deploying the anchoring device, removing the anchoring device, and removing the obstructing member. The anchoring device may include a projection that piercingly engages the obstructing member and the air passageway wall. The anchoring device may include a projection that piercingly engages the obstructing member and the air passageway wall. The projection may be releasable from the air passageway wall for removal of the anchoring device, and the step of removing the anchoring device includes releasing the projection. The obstructing member may form a one-way valve. A portion of the anchoring device may be collapsible.
Yet another embodiment provides an air passageway obstructing device having obstructing means for obstructing air flow within the air passageway, and anchoring means for anchoring the obstructing means within an air passageway by engaging the obstructing means and the air passageway, and the anchoring means being further releasable for removal of the obstructing means.
These and various other features as well as advantages which characterize the present invention will be apparent from a reading of the following detailed description and a review of the associated drawings.
The features of the present invention which are believed to be novel are set forth with particularity in the appended claims. The invention, together with further objects and advantages thereof, may best be understood by making reference to the following description taken in conjunction with the accompanying drawings, in the several figures of which like referenced numerals identify identical elements, and wherein:
In the following detailed description of exemplary embodiments of the invention, reference is made to the accompanying drawings that form a part hereof. The detailed description and the drawings illustrate specific exemplary embodiments by which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention. It is understood that other embodiments may be utilized, and other changes may be made, without departing from the spirit or scope of the present invention. The following detailed description is therefore not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims.
Throughout the specification and claims, the following terms take the meanings explicitly associated herein unless the context clearly dictates otherwise. The meaning of “a”, “an”, and “the” include plural references. The meaning of “in” includes “in” and “on.” Referring to the drawings, like numbers indicate like parts throughout the views. Additionally, a reference to the singular includes a reference to the plural unless otherwise stated or inconsistent with the disclosure herein.
Additionally, throughout the specification, claims, and drawings, the term “proximal” means nearest the trachea, and “distal” means nearest the bronchioles.
Briefly stated, an anchored intra-bronchial device is provided for placement in an air passageway of a patient to collapse or reduce ventilation to a lung portion associated with the air passageway. An obstructing member is first placed in the air passageway, and then an anchoring device is deployed which anchors the obstructing member in place. A further aspect of the invention provides removability of the intra-bronchial device by releasing the anchoring device for removal of the obstructing member.
The respiratory system 20 includes the trachea 28, the left mainstem bronchus 30, the right mainstem bronchus 32, the bronchial branches 34, 36, 38, 40, and 42 and sub-branches 44, 46, 48, and 50. The respiratory system 20 further includes left lung lobes 52 and 54 and right lung lobes 56, 58, and 60. Each bronchial branch and sub-branch communicates with a respective different portion of a lung lobe, either the entire lung lobe, a segment, or a portion thereof. As used herein, the term “air passageway” is meant to denote either bronchi or bronchioles, and typically means a bronchus branch or sub-branch that communicates with a corresponding individual lung lobe, segment, or lung lobe tissue portion to provide inhaled air thereto or conduct exhaled air therefrom.
Characteristic of a healthy respiratory system is the arched or inwardly arcuate diaphragm 26. As the individual inhales, the diaphragm 26 straightens to increase the volume of the thorax 22. This causes a negative pressure within the thorax. The negative pressure within the thorax in turn causes the lung lobes to fill with air. When the individual exhales, the diaphragm returns to its original arched condition to decrease the volume of the thorax. The decreased volume of the thorax causes a positive pressure within the thorax which in turn causes exhalation of the lung lobes.
In contrast to the healthy respiratory system of
It has been found that the apex portions 62 and 66 of the upper lung lobes 52 and 56, respectively, are most affected by COPD. Hence, bronchial sub-branch obstructing devices are generally employed for treating the apex 66 of the right, upper lung lobe 56. However, as will be appreciated by those skilled in the art, the present invention may be applied to any lung portion without departing from the present invention. As will be further appreciated by those skilled in the art, the present invention may be used with any type of obstructing member to provide an anchored obstructing device, which may be removed. The inventions disclosed and claimed in U.S. Pat. Nos. 6,258,100 and 6,293,951, both of which are incorporated herein by reference, provide an improved therapy for treating COPD by obstructing an air passageway using an intra-bronchial valve or plug. The present invention may be used with the apparatus, system, and methods of these patents as will be briefly described in conjunction with the disclosure of the preferred embodiments of the present invention.
The insertion of an obstructing member treats COPD by deriving the benefits of lung volume reduction surgery without the need of performing the surgery. The treatment contemplates permanent partial or complete collapse of a lung portion to reduce the volume of lung mass. This leaves extra volume within the thorax for the diaphragm to assume its arched state for acting upon the remaining healthier lung tissue. As previously mentioned, this should result in improved pulmonary function due to enhanced elastic recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricle filling. The present invention supports the use of intra-bronchial plugs to treat COPD by anchoring the obstructing member in the air passageway. The present invention further supports the use of intra-bronchial plugs by providing for their removal if necessary. Use of anchors can allow the obstructing member to be relatively loosely fitted against the air passageway wall, which may provide increased mucociliary transport of mucus and debris out of the collapsed lung portion.
A function of the intra-bronchial device disclosed and claimed in this specification, including the detailed description and the claims, is described in terms of collapsing a lung portion associated with an air passageway to reduce lung volume. In some lungs, a portion of a lung may receive air from collateral air passageways. Obstructing one of the collateral air passageways may reduce the volume of the lung portion associated with the air passageway, but not completely collapse the lung portion as that term may be generally understood. As used in the description and claims herein, the meaning of “collapse” includes both a complete collapse of a lung portion and a partial collapse of a lung portion.
Once deployed, the obstructing member precludes inhaled air from entering the lung portion to be collapsed. In accordance with the present invention, it is preferable that the obstructing member takes the form of a one-way valve. In addition to precluding inhaled air from entering the lung portion, the member further allows air within the lung portion to be exhaled. This results in more rapid collapse of the lung portion. In addition, anchoring obstructing members that preclude both inhaled and exhaled airflow are contemplated as within the scope of the invention.
More specifically, the obstructing member 90 has an outer dimension 91, and when expanded, enables a contact zone with the air passageway inner dimension 51. This seals the air passageway upon placement of the obstructing member 90 in the air passageway 50 for maintaining the lung portion 66 in the collapsed state. The projections of the anchor 100 have engaged the obstructing member 90 and the wall of air passageway 50 by piercing into both. This engagement anchors obstructing member 90 against movement distally or proximally, such as might be caused by breathing, sneezing, coughing or gasping.
Alternatively, the lung portion 66 may be collapsed or reduced in volume using a vacuum prior to placement of obstructing member 90, or sealing the air passageway 50 with obstructing member 90 may collapse it. Over time, the air within the lung portion 66 will be absorbed by the body and result in the collapse of lung portion 66. Alternatively, obstructing member 90 may include the function of a one-way valve that allows air to escape from lung portion 66. Lung portion 66 will then collapse, and the valve will prevent air from being inhaled.
The base 101 of anchoring device 100 carries support members 102, 104, 106, and 108. The support members 102, 104, 106, and 108 carry projections 112, 114, 116, and 118, and projection ends 122, 124, 126, and 128, respectively. Base 101 is a tubular member, preferably hypodermic needle tubing. Support members 102, 104, 106, and 108, are coupled mechanically to base 101, such as by crimping, or by other methods such as adhesive or welding. Support members 102, 104, 106, and 108 are generally similar to each other. The support members are preferably formed of stainless steel, Nitinol, or other suitable material having a memory of its original shape, and resiliency to return the material to that shape. The support members and anchors may be formed by laser cutting a single tubular member, such as hypodermic needle tubing, lengthwise and bending the support members to the appropriate shape.
Projections 112, 114, 116, and 118 are portions of support members 102, 104, 106, and 108, respectively, and are at an end opposite to the end coupled to base 101. The support members and the projections are formed in a configuration that will result in the memory and resiliency of their material moving at least the projections proximally upon deployment to a position to engage the obstructing member and the air passageway wall by piercing. In this preferred embodiment, the configuration is a curve having a decreasing radius toward the projection ends, such that the projection ends will pierce the air passageway wall at an angle that provides sufficient shear resistance to anchor the obstructing member. The angle is a function of the design parameters of anchor device 100, and the more near perpendicular the angle is, the better the shear resistance will be. Projection ends 122, 124, 126, and 128 are shaped to promote piercing of an obstructing member and an air passageway wall. Stops 132, 134, 136, and 138, are shaped and dimensioned to limit the piercing by the projections, and generally consist of a widened area such as a shoulder between support members 102, 104, 106, and 108, and projections 112, 114, 116, and 118, respectively. The stops may be formed from the same material as the support member and its projection, or in an alternative embodiment, may be formed separately and coupled to the support member.
In an alternative embodiment, base 101, support members 102, 103, 104, 105, 106, and 108, projections 112, 114, 116, and 118, projection ends 122, 124, 126, and 128, and stops 132, 134, 136, and 138, may be formed by laser cutting a single tubular member lengthwise, and bending the support members and projections to a required shape. The tubular member is preferably hypodermic needle tubing, or may be stainless steel, Nitinol, or other suitable material having a memory of its original shape and resiliency to return the material to that shape.
Obstructing member 90 is collapsible for insertion into an internal lumen of a catheter. Obstructing member 90 is inserted into the catheter lumen, which is typically already placed in the air passageway 50 as generally illustrated in
Anchoring device 100 is collapsed into a first position for insertion into the internal lumen of a catheter, which may be the same catheter that placed the obstructing member 90. Anchoring device 100 is inserted into the catheter lumen and advanced down the catheter lumen by pushing the stylet against base 101. Anchoring device 100 is advanced into the air passageway 50 to where it is to be deployed in proximity to obstructing member 90 as generally illustrated in
In another alternative embodiment, the anchoring device 100 is self-deploying. The memory and resiliency of the material of support members 102, 104, 106, and 108 provide sufficient urgency to force projections 122, 124, 126, and 128 to engage the obstructing member 90 and the air passageway wall 130 by piercing.
The preclusion of air from being inhaled into the lung portion may be terminated by eliminating the obstructing effect of intra-bronchial device 140. The preclusion of air by the embodiment illustrated in
Annular member 162 has a periphery 164 and an aperture 152. Annular member 162 carries projections 172, 174, 176, and 178 on its periphery 164. Projection ends 182, 184, 186, and 188 are shaped to promote piercing of an obstructing member and an air passageway wall by the projections. Stops 192a-b, 194a-b, 196a-b, and 198a-b may be formed on the periphery 164 of annular member 162 adjacent to projections 172, 174, 176, and 178, respectively. The “a” stop and the “b” stop are disposed on opposite sides of a projection. Stops 192a-b, 194a-b, 196a-b, and 198a-b are shaped and dimensioned to limit the piercing of an obstructing member and an air passageway wall by the projections. In an alternative embodiment, the stops may form a shoulder completely around a perimeter of the projection.
Annular anchoring device 150 is made from stainless steel, Nitinol, or other suitable material having a memory of its original shape and resiliency to return the material to that shape. In an embodiment, annular anchoring device 150 is formed from a single piece of material, such as laser cutting, stamping, or other methods as are known to those in the art. Annular anchoring device 150 may have any cross-sectional shape compatible with its material and layout, which may be flat, elliptical, or rectangular. The number of projections, and the shape and configuration of the projection, may be selected as will provide sufficient engagement to anchor obstructing member 90.
In an alternative embodiment, the projections and their ends are arranged to frictionally engage without piercing. In a further alternative embodiment, the projections may be divided into sets, one set arranged to pierce and another set arranged not to pierce. One set of projections of this embodiment is further arranged to engage only the obstructing member 90 and the another set is arranged to engage only the air passageway wall 130.
In a preferred embodiment, anchoring device 150 is arranged to be balloon expandable into its fully deployed configuration illustrated in
Obstructing member 90 is placed in air passageway 50 in the manner described in conjunction with
In an alternative embodiment, the deployment includes expansion by the memory and resiliency of the material of anchoring device 150 urging the projections 172, 174, 176, and 178 to engage the obstructing member 90 and the air passageway wall 130. In a further alternative embodiment, the expansion may be provided or supplemented by a device deployed through the catheter that engages and expands aperture 152 to move anchoring device 150 into its deployed, or second position.
The preclusion of air from being inhaled into the lung portion may be terminated by eliminating the obstructing effect of intra-bronchial device 200. The preclusion of air by the embodiment illustrated in
While particular embodiments of the present invention have been shown and described, modifications may be made. It is therefore intended in the appended claims to cover all such changes and modifications that fall within the true spirit and scope of the invention.
The present application is a continuation of U.S. application Ser. No. 10/124,790 filed Apr. 16, 2002, the entire contents of which is incorporated herein by reference.
Number | Date | Country | |
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Parent | 10124790 | Apr 2002 | US |
Child | 11781130 | Jul 2007 | US |