Cy Kennedy stopped smoking when the damage had already been done.
He had developed emphysema, the chronic illness that caused his labored breathing and left him exhausted and depressed. Hooked up to a portable oxygen tank, Kennedy could make the mundane trip to the grocery store, but he stayed mostly at home.
"I can't continue like this," the Wheaton man told his doctor. "What else can we do?"
It wasn't a hopeless question.
Kennedy, 77, became only the second patient at Northwestern Medicine Central DuPage Hospital to have a valve procedure that doctors consider a major medical advance in the treatment of emphysema.
"I would describe this technology as nothing short of revolutionary," said Dr. Benjamin Seides, a pulmonologist at the Winfield hospital. "We have ways to limit the symptoms, slow the progression of the emphysema, but now we have a minimally invasive option to actually make patients feel better, improve their quality of life, live better."
His breathing has vastly improved, and a rejuvenated Kennedy is living his best life.
'Nothing else matters'
Try taking a half a breath, and without exhaling, breathe from there. It's a difficult, uncomfortable simulation of what breathing is like for people with emphysema.
"We have a saying in interventional pulmonology: 'When you can't breathe, nothing else matters,'" Seides said. "And so the thing we take for granted, people who don't have emphysema, people with emphysema think about every minute of every day."
Emphysema is a debilitating form of chronic obstructive pulmonary disease, the nation's fourth-leading cause of death. Most emphysema in this country is due to smoking, but there are other causes, including a condition called alpha-1 antitrypsin deficiency and exposure to pollution, Seides said.
"There is a significant and rising group of people who have COPD or emphysema who are never smokers," he said.
Healthy lungs have millions and millions of delicate, cauliflower-like air sacs called alveoli, where carbon dioxide leaves the blood and oxygen enters it. In patients with emphysema, those structures become like dilated balloons with much less surface area, causing problems with gas exchange.
"So you have this dysfunctional lung that is now not only not working well, but also crowding out the rest of the lung," Seides said.
Emphysema slowly develops over time. Kennedy remembers carrying a pack of cigarettes to his freshman year of high school, before the landmark 1964 surgeon general's warning of the health hazards from smoking.
Kennedy would smoke as many as two packs a day and used pipe tobacco and electronic cigarettes. He quit after he learned he had emphysema 10 years ago and eventually became physically unable to walk around his neighborhood.
"I might be able to go to the Jewel or something with oxygen and walk around or go to a store for 10 minutes or something, but when you can't even walk to the end of your block, it's restrictive," he said.
Medications and pulmonary rehab can help keep symptoms at bay. But for patients with "severe, life-limiting emphysema," Seides said there have long been two treatment options: lung volume reduction surgery, a major operation; or a lung transplant, a lifesaving intervention.
More than a year ago, the Food and Drug Administration approved a far less invasive approach.
Using a flexible bronchoscope, doctors deploy one-way, cylindrical valves via a catheter into airways to block off the most diseased parts of the lungs. California-based Pulmonx Corp. makes the valves.
"So the valve procedure actually reduces the absolute amount of lung tissue actively exchanging air, but in selectively removing the most damaged and hyperinflated parts of the lung, it allows the remaining, less-damaged lung to perform its function more efficiently, which, importantly, improves symptoms and quality of life for the patient," Seides said in a follow-up email.
Since Central DuPage Hospital launched its Zephyr valve program in July, Seides has done about 10 procedures, with 40 more patient candidates at various stages of a "fairly robust, pre-procedure work-up" to screen.
To date, CDH is the only hospital in Chicago's suburbs with a Zephyr valve program where the procedure has been performed. Since FDA approval on June 29, 2018, more than 500 valve procedures have been done in the United States.
"The opportunity to make these potential benefits available to a much wider group of patients without having to undergo surgery is huge because it works," Seides said. "And so this is the kind of thing we as doctors live for, the opportunity not just to help keep disease at bay, but really help patients feel better."
Kennedy had five valves inserted. Each costs about $2,500.
"Medicare covers it, no problem," Seides said. "Other insurance companies, as is typical with new technologies and new therapies, are slow to sort of authorize this. They are coming on board slowly but surely. Part of our process when we're doing the work-up is working with the insurance companies, so we initiate that right at the start."
The procedure takes about 45 minutes to an hour. Doctors keep a close eye on patients who are electively admitted into the hospital for three to four days after receiving the valves, so physicians have the ability to address a pneumothorax, or a collapsed lung, should one arise.
It's too early to say whether the procedure will prolong the lives of people with severe emphysema. But it may delay or possibly prevent the need for a surgical lung volume reduction or transplant, Seides said.
A new life
Kennedy began feeling better just hours after Seides implanted the valves in July, and it's made a world of difference.
"I'm breathing more deeply," he said.
And breathing on his own. He sleeps with oxygen at night only for peace of mind.
"When you don't have to use oxygen, and you're able to walk, you don't have to use the rescue inhaler, it's marvelous," he said.
But what's almost impossible to measure is his gratitude for being able to travel like he used to with his wife and family. Retired from a career owning and operating cosmetology and barber schools, Kennedy is planning a trip to Las Vegas to see his granddaughter play in a soccer tournament in January. And then it's off to Mexico in February.
"For me, it's been a life-changer," he said.