For nine years British citizen Chris Ryan struggled to breathe after being diagnosed with a chronic lung disease.
The 72-year-old, who has been living in South Africa for 47 years, was considering using his British citizenship to have an endoscopic lung volume reduction (ELVR) procedure performed in the UK — which improves the quality of life of some patients living with chronic obstructive pulmonary disorder (COPD).
Pandemic delays, long National Health Service waiting lists and the exorbitant cost of a private procedure put paid to Ryan's attempts to seek treatment abroad.
When Ryan learnt from a UK-based respiratory specialist that South African doctors were going to perform the continent's first ELVR, he put himself up for consideration.
30 to 60 minutes - the time the ELVR procedure takes to perform
3 to 5 valves are used
— IN NUMBERS:
After rigorous screening, which included CAT scans and lung function, Ryan was deemed a suitable candidate.
Ryan and Western Cape pensioner Charmaine Henning, diagnosed with COPD in 2019, last month became the first two patients in Africa to have the reduction procedure.
The operation involves inserting small valves into the lung to increase breathing capacity.
Performed by Prof Coenie Koegelenberg and Dr Dante Plekker, pulmonologists at Netcare Kuils River Hospital in the Western Cape, the procedure is offered at healthcare facilities globally but has only now reached Africa.
Doctors had to convince medical aid schemes that ELVR is effective, which delayed the performance of the procedure.
Koegelenberg, who is also a professor in the division of pulmonology at Stellenbosch University's medicine department and Tygerberg Hospital, said multiple clinical trials indicated ELVR can improve symptoms as well as lung function.
“This enhances quality of life in patients with COPD and emphysema who meet the selection criteria to undergo the procedure.
“Appropriate patient selection is vital to the success of this treatment. Patients need to undergo a rigorous clinical as well as physiological workup including complete lung function tests.
“Additionally, a high resolution CAT scan of the lungs is required which is assessed with a specialised software program to determine if a suitable lobe is present for treatment.
He said during the minimally invasive procedure a flexible fibreoptic camera or bronchoscope is used to insert small one-way valves into the lobe of the lung that is most affected by disease.
“This aims to deflate the treated lobe so that airflow can be redirected to healthier parts of the lungs.
"The procedure reduces hyperinflation and improves the mechanics of breathing. It, however, does not cure COPD or emphysema.”
The Global Initiative for Chronic Obstructive Lung Disease guidelines as well as the UK National Institute for Health and Care Excellence have advocated for the use of endoscopic valves in suitable patients.
Koegelenberg said COPD remains one of the most common causes of morbidity and mortality in South Africa.
Plekker said: “The main delay was with convincing healthcare funders that the procedure is effective and worth paying for. The cost of the valves are high and you typically need four to five to treat one patient.”
He could not provide a cost because it varies depending on the number of valves used.
Ryan said he felt an immediate improvement in his breathing after the procedure.
“I am looking forward to further improvements in the near future. I have started playing golf again and look forward to getting back to an active lifestyle I have always had in the past.
For Henning, 66, the procedure has given her a new lease on life after years of illness that left her unable to perform even the most basic activities without pausing to catch her breath.
“I cannot believe it but the next day, even that same afternoon after the procedure, I could feel a difference.
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