Introduction and objectives Lung volume reduction (LVR) via unilateral VATS or endoscopic placement of endobronchial valves (EBV) in carefully selected individuals with severe emphysema can result in a major improvement in quality of life. Despite being approved by NICE, there remains patchy service provision across the UK.1
In 2010, we established a multidisciplinary COPD Hyperinflation service for our region. There is a scarcity of information on such services and we report on our referral outcomes for 2015.
Methods Our Hyperinflation MDT includes specialist COPD physician, specialist nurse, thoracic radiologist, thoracic surgeon, interventional pulmonologist and transplant physician. We review clinical features, CT and lung function to decide on specialist assessment, progressing to detailed physiological assessment, lung perfusion scanning and MDT discussion in some. We retrospectively reviewed outcomes on 120 patients referred for LVR assessment between 1/1/15–31/12/15.
Results 111 patients underwent specialist assessment. 20% of patients were discharged, as they did not meet NICE criteria. Nonetheless, many of these patients benefited from clinical phenotyping and management recommendations. 67% of patients were discussed at MDT. 35% of patients were not offered LVR (high risk and lack of hyperinflation targets). 64% of patients were deemed suitable for LVR or transplantation [(EBV or LVRS 37%; LVRS 35%; EBV 15%; EBV bridging to transplantation 7%; transplant 4% (Figure 1)]. One patient received endobronchial coils as part of a clinical study. Patients who are considered suitable for EBV with intact or <10% defect in fissure undergo bronchoscopic balloon catheter assessment for collateral ventilation.
Conclusion Our experience with this service model shows that LVR can be incorporated into existing pathways. Our model has evolved to triage patients at various points to ensure high quality discussion of selected patients at the dedicated MDT. As a result, the proportion of patients at the MDT offered LVR procedures is relatively high. MDT expertise allows optimal patient selection with effective utilisation of existing resources. We hope that these data will stimulate others to develop local models of care to enable better access to LVR for COPD patients.
McNulty W, et al. BMJ Open Respirat Res 2014;1:e000023.