Despite optimal medical care with smoking cessation, pulmonary rehabilitation and medications, many people with chronic obstructive pulmonary disease (COPD) remain breathless and limited. In some patients, with the appropriate pattern of lung destruction, an operation called lung volume reduction surgery (LVRS) is effective. This removes the worst affected area of lung, which means that the remaining lung can function more effectively. New techniques allow the lung to be treated using a fibre-optic camera called a bronchoscope. Trials have shown that using a bronchoscope to place valves into the airways to block off the worst part of the lung can be effective in carefully selected patients and the technique is now being adopted in hospitals across the UK.
Although it is a small proportion of COPD patients it is still a large number of people. There are very roughly estimated to be 15,000 eligible patients in the UK. However, despite LVRS having a Grade A evidence base, referral for the procedure is extremely patchy and only about 100 operations occur each year. This project will review data in detail to help highlight the problem and establish a strategy for identifying potential candidates systematically so they are able to access this treatment.
As a national sample of current practice, we will use linked CPRD GOLD data with HES and ONS to undertake a cohort study to provide an accurate estimate of the number of people with COPD who may be eligible for LVRS or other LVR procedures. This will be based on measures of disease severity, breathlessness and comorbidity and whether they have taken part in pulmonary rehabilitation. We will also establish whether there is evidence that they have had a CT scan (using HES DID). Participation in pulmonary rehabilitation and hospital admission will be recorded to see if these events could be used as a trigger for LVRS assessment. The information obtained from this study will be used to inform the development of models and strategies to improve access to this form of treatment and reduce health inequality which can then be used as a national resource.
Distribution of people who may be eligible for assessment for LVRS. Prevalence of LVRS eligibility Proportion of these who have documented exclusions (pulmonary hypertension, continued smoking) Proportion of these who have taken part in pulmonary rehabilitation within the last year or ever. Proportion who have had a CT scan in last 3 years Proportion who have been admitted to hospital with an acute exacerbation of COPD in the last 3 years Proportion who have a COPD patient unsuitable for pulmonary rehabilitation code.
Jennifer Quint - Chief Investigator - Imperial College London
Jennifer Campbell - Collaborator - CPRD
Nicholas Hopkinson - Collaborator - Imperial College London
HES Admitted Patient Care;HES Diagnostic Imaging Dataset;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation