Eligibility for lung volume reduction in patients with COPD attending pulmonary rehabilitation

Buttery, Sara, Lewis, Adam, Kemp, Samuel V., Quint, Jennifer K., Steiner, Michael C. and Hopkinson, Nicholas S. (2020) Eligibility for lung volume reduction in patients with COPD attending pulmonary rehabilitation. European Respiratory Journal, 56 (64), [4096]. (doi:10.1183/13993003.CONGRESS-2020.4096).

Abstract

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<50%, 6 Minute Walk Distance (6MWD) ≥140m, ex or non smoker and limiting breathlessness [1]. We used a cut off of >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.

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Contributors

Author: Adam Lewis

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