The Centers for Disease Control and Prevention (CDC) estimates that 16 million Americans are affected by chronic obstructive pulmonary disease (COPD), which is a group of diseases that disrupt breathing and airflow through the lungs. While there is no cure for these diseases, certain treatments and medical devices, such as Zephyr valves, can improve a person’s quality of life.

Understanding How a Zephyr Valve Works

Both emphysema and chronic bronchitis are classified as COPD. People who have been diagnosed with severe emphysema experience breathing problems due to lung damage that prevents the lung tissue from taking in enough oxygen or from properly expelling old air from the alveoli (air sacs) within the lung’s walls.

The procedure, performed by a doctor using a bronchoscope, involves placing the small valves inside of airways that have been damaged by emphysema. Once in place, their unique valve system helps prevent air from reaching the damaged portion of the lung during inhalation and also helps release trapped air during exhalation.

By relieving the lungs from built-up pressure, people with emphysema can breathe easier. This can help improve their performance of everyday tasks, such as walking or taking care of their home, and has a positive impact on their overall quality of life. Patients who are able to make use of this treatment may be able to avoid more invasive procedures, which can include surgery to reduce lung volume or lung transplants.

Side Effects and Risks Associated with a Zephyr Valve

It is possible for some patients to experience worsening symptoms or develop pneumonia after implantation. Some patients have also reported an increase in mucous or wheezing. During the recovery period after the procedure, some patients may also have a higher-than-average risk of experiencing an air leak in the lungs. Zephyr valves are designed to be permanent, but they can be removed if a patient does not respond well to the treatment.

Any risk factors will be carefully examined before the procedure is performed. If certain preexisting conditions are present, your doctor may recommend against implanting Zephyr valves. If the condition is expected to be temporary, your doctor may approve implantation once the condition resolves.

Examples of contraindicated conditions can include:

  • Active pulmonary infection
  • Conditions which prevent a bronchoscopic procedure
  • Known allergies to valve components, such as nickel, titanium or silicone
  • Current smokers
  • Presence of enlarged bullae that encompass more than 30% of a lung

Patients who have a history of heart disease or have undergone a lung transplant may also need careful examination before being approved for the use of Zephyr valves. Patients who have Zephyr valves should also make their health care professionals aware of they have these implantations before undergoing an MRI, which will allow the health care professional to review any MRI safety requirements related to these devices.

Medicare Coverage for a Zephyr Valve

Because this procedure is performed in a hospital setting and may require the patient to stay for up to three days post-procedure to be observed for any adverse reactions, Medicare Part A provides coverage for Zephyr valve implantation. Medicare recipients have certain cost-sharing obligations, such as deductibles and coinsurance amounts, under Part A coverage terms.

These out-of-pocket expenses under Original Medicare can be reduced and some benefits can be enhanced if the Medicare recipient chooses a Medicare Supplement Plan, also known as a Medigap Plan. Medigap plans may cover Part A coinsurance and hospital costs, and some cover a Part A deductible. Medigap plans are offered under standardized letter-based names in most states, but not every insurance carrier provides every Medigap plan in each state.

As an alternative to Original Medicare, Medicare Advantage plans include the same Part A and Part B benefits as Original Medicare, but many offer additional benefits. Costs and coverage can differ by location and insurer.

Low-income Medicare recipients who are also eligible for Medicaid Savings Programs may also have their out-of-pocket expenses reduced or eliminated by this additional coverage. Each state sets their own eligibility rules, so applicants must consult with their local agency for more information on those requirements and benefits.

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