Eligibility for Lung Volume Reduction in patients with COPD attending Pulmonary Rehabilitation

Background: Lung volume reduction (LVR) therapies are highly effective in appropriately selected patients with COPD. NICE (2018) guidance recommends offering a respiratory review for LVR assessment at the end of pulmonary rehabilitation (PR), if certain criteria apply. Few data exist on likely numbers potentially eligible according to these criteria [1]. Methods: Data from the 2015 and 2017 UK Royal College of Physicians National Asthma and COPD Audits were used to identify numbers of patients completing PR potentially eligible to be assessed for LVR based on NICE guidelines; FEV1 80m for the incremental shuttle walk test (ISWT) and breathlessness criteria of either MRC dyspnoea score >3 or ≥3. Results: 8,295 (55.7%) of 14,889 patients in programs using ISWT or 6MWD to assess change in exercise capacity completed PR, and 4,856 (32.6%) had complete data recorded. Of these 310 (6.4%) were eligible to be considered for LVR assessment, at a breathlessness threshold of MRC score >3. Relaxing the criteria to include MRC≥3, meant 881 (18.1%) would be eligible. Conclusions: A systematic approach to identify potential candidates for LVR, during and at the end of PR, is desirable. Approaches for the appropriate evaluation of non-completers also need to be considered. Whittaker H Eligibility for Lung Volume Reduction Surgery in Patients With COPD Identified in a UK Primary Care Setting Chest 2019 https://doi.org/10.1016/j.chest.2019.07.016 Hopkinson et al COPD: Diagnosis and Management: Summary of Updated NICE Guidance. BMJ 2019;366:l4486