The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction

Abstract

Chronic obstructive pulmonary disease (COPD) is a complex disease and the management is focused on improving breathlessness, quality of life and healthcare utilisation. Our understanding of COPD phenotypes has improved in recent years and there is an increased drive towards delivering phenotype-based therapies. Lung volume reduction can offer the prospect of life changing benefit in breathlessness and quality of life in a select group of patients with severe emphysema already receiving maximum medical treatment. In spite of the available evidence, very few procedures are being performed relative to the disease burden and prevalence of suitable individuals. Currently the major barriers to patient accessibility are lack in standardised multidisciplinary severe COPD services with easy access to lung volume reduction procedures, as well as poorly informed perceptions of healthcare professionals. There is a recognised need to improve such services in many healthcare systems. We share our experiences with setting up and running a successful regional multidisciplinary severe COPD hyperinflation service.

Keywords: Emphysema; chronic obstructive pulmonary disease (COPD); lung volume reduction; multidisciplinary team (MDT).

Figure 1

Multidisciplinary team. COPD, chronic obstructive pulmonary disease.

Figure 2

Referral pathway for patients being referred for lung volume reduction in Cambridge. COPD, chronic obstructive pulmonary disease; MDT, multidisciplinary team; LVR, lung volume reduction; LVRS, lung volume reduction surgery; EBV, endobronchial valve; FEV₁, forced expiratory volume in one second; RV, residual volume; TLCO, transfer factor for carbon monoxide; CT, computed tomography.