Lung volume reduction and how can it help people with COPD

Dr Nick Hopkinson, BLF Medical Director, talks about his fascinating work on lung volume reduction, which has already brought good news for many people with COPD.

About COPD

COPD stands for chronic obstructive pulmonary disease. Chronic because it’s a condition that persists, obstructive because people who have it have problems moving air in and out of their lungs, they have airflow obstruction, pulmonary because it’s to do with the lungs, and disease because it’s a medical condition.

It is usually caused by damage to the lungs from inhaling noxious materials, mostly tobacco smoke, but also occupational exposures as well can cause it. People with the condition can have bronchitis, and they can have damage to the lung tissue, which is called emphysema. The blood vessels in the lung can get damaged as well, so the blood isn’t as able to take up oxygen when people breathe. And all of those things together mean that it causes breathlessness and that can be very limiting to peoples’ lives.

People with COPD often have a cough, they often cough up sputum and they also can get what is called acute exacerbations, which are usually caused by chest infections, where their condition gets dramatically worse.

How it affects day to day life

It’s a progressive condition, so it often starts quite insidiously, people may feel a little bit breathless, they may stop doing their ordinary activities, or do them more slowly, and often it’s a while before the penny drops that there’s a real underlying lung problem. As it progresses, it can become completely disabling. People with more severe disease can find it difficult to get from room to room in their house, they get out of breath washing and dressing.

Lung volume reduction surgery

When people have got emphysema, the lung tissue breaks down. In normal healthy lungs, the lungs are quite springy and elastic and that’s all the tiny air sacs where oxygen is taken up and carbon dioxide is released. A healthy lung is like a springy sponge. What happens with emphysema is that breaks down, the lungs become baggy and they don’t empty properly, so air gets trapped inside the lung. So, a person can breathe in, but when they try and breathe out, the airways close and there’s air trapped and getting in the way.

What lung volume reduction procedures try to do is to get rid of the worst affected part of the lung so the healthier part of the lungs can work better, and the person can breathe more comfortably. There are basically two main types:

One is lung volume reduction surgery, we have a keyhole operation to remove the worst affected part of the lung.

And the other is what’s called endobronchial valves, so rather than cutting the bad part of the lung out, the person has a bronchoscopy, where a little fibre optic camera goes down into the lung and little valves are placed into the airways inside the lungs that stop air getting to that worse part of the lung.

These treatments can have a really big impact. They can turn the clock back several years, improve breathlessness, people can walk further, and the evidence is actually that they improve survival in people with severe emphysema, so they’re potentially very beneficial.

The research that Asthma UK and the British Lung Foundation have recently supported

The research was setting up a national register for these procedures and that’s had a really substantial impact. Lung volume reduction surgery has been around for more than 20 years and valve treatment is a little more recent than that, but they’re both treatments that are done in a few specialist centres and most people with COPD never get considered for them and never get anywhere near having one of the procedures. When we’ve talked to patients about this, one of the things that comes back is this line, “I had to fight to get a referral.”

There isn’t a systematic approach to it, so you think if you had a treatment like this that was going to have a huge impact, then people would be trying very hard to find the patients that would benefit because one of the things about it is it works very well, but only in very carefully selected people.

We wanted to set up a register to link up all the different centres that were doing it, to identify the centres that were involved, make sure that everybody was selecting people appropriately and begin to gather data about longer-term outcomes.

By setting up this community, this register, we were able to go to NHS England and say, “We think you should commission lung volume reduction procedures for people with COPD.” Part of the argument, apart from just how effective these treatments are individually, was that the health system would be able to implement them in a way that was responsible and effective. That was successful and NHS England has now approved these procedures for carefully selected people with COPD.

In a nutshell, this research has led to changes in the way that people with COPD are treated by helping to ensure that people who are likely to benefit from lung volume reduction surgery can access it.

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