Approach to selecting patients with emphysema for a possible lung volume reduction procedure
| General criteria when considering a lung volume reduction procedure ▸ Significantly reduced exercise capacity. ▸ Lung function impairment with significant hyperinflation. ▸ Sufficiently well to cope with surgery. ▸ Prepared to accept some procedural risk (requires clinicians to be able to communicate this accurately). ▸ There is a ‘window of opportunity’ for intervention. In ‘end-stage’ patients, it may be too late to intervene safely. | |
| Considerations | Criteria |
| ▸ Are they too well to consider intervention? | ▸ Lung function, exercise capacity, prognosis, Medical Research Council dyspnoea score <3 |
| ▸ Are they too unwell for intervention to be safe? | ▸ Lung function, frailty, exercise capacity <100 m, oxygen dependence |
| ▸ Is treatment optimal? | ▸ Smoking cessation, pulmonary rehabilitation, flu vaccination, inhaled and oral medication |
| ▸ Is their lung function likely to rule out a procedure on safety grounds? | ▸ All three of FEV1, TLco and Kco <20% predicted |
| ▸ Do they have comorbidities that limit likely benefit or increase risk? | ▸ For example, pulmonary hypertension, unstable cardiac disease, malignancy, cerebrovascular disease. Ongoing smoking (possibility of intervention may help to promote quit attempts) |
| ▸ Have they ever had a CT thorax and if so has it been reported in terms of emphysema pattern? | ▸ Review existing CT's or obtain a CT if a potential candidate as above |
| Review CT and lung function in multi-disciplinary teams including respiratory physician, radiologist, thoracic surgeon Further investigations including echocardiogram, lung perfusion scan and a formal field exercise test (shuttle walk or 6 minute walk test) may be indicated. | |