Lung volume reduction surgery - an underutilised treatment?

Abstract

Introduction: Lung volume reduction surgery (LVRS) is recommended by NICE guidance for a select group of patients with emphysema and hyperinflation. Benefits include improved lung function, exercise performance, quality of life and survival benefit (NETT trial). At Queen Elizabeth Hospital in Birmingham we evaluated whether patients followed up in the complex COPD clinic had been considered for LVRS.

Method: Retrospective review of electronic records for all patients reviewed in the complex COPD clinic between January and June 2018. Co-morbid conditions, smoking status, enrolment into pulmonary rehabilitation and other physiologic parameters were reviewed. Analysis included individuals with disabling COPD defined as post bronchodilator FEV1 ≤50% predicted and MRC dyspnoea scale ≥3.

Results: 380 patient records were reviewed. Many had other causes of breathlessness or comorbidities that preclude LVRS e.g. comorbid asthma, severe bronchiectasis and significant cardiac disease. 195 had disabling COPD as defined above; 54 current smokers (28%); 71 (37%) had completed pulmonary rehabilitation by the time of review; 13 (7%) had documented advanced care plans. Of the 195 patients, 16 were thought to be suitable for LVRS. Of these:

Conclusion: Managing COPD in the complex COPD clinic allows optimisation of patients with multi-professional input and if appropriate discussion of complex care planning or intervention. A small number of individuals are identified to be LVRS candidates yet LVRS remains underutilised.