Lung volume reduction procedures in chronic obstructive pulmonary disease – outcomes and access
File(s)
Author(s)
Hudson, Sara
Type
Thesis
Abstract
Abstract
Lung volume reduction (LVR) therapies represent a potentially life changing treatment option for carefully selected patients with severe emphysema who derive little symptomatic benefit from traditional management plans. However, selection criteria are unclear and no formal referral pathways currently exist. This means that the number of patients undergoing LVR treatment in the UK may be disproportionate to the number eligible and that many may be missing out on these important treatments.
At present, there are two procedures available to patients that fit specific eligibility criteria for LVR that are both recognised in national and international guidelines and have a large body of robust evidence proving their efficacy. These procedures are lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs). However, there is currently no published data that directly compares the two procedures to establish which is superior for those that have equipoise for either treatment.
The work presented in this thesis has the primary objective of improving outcomes and access to LVR interventions for people with Chronic Obstructive Pulmonary Disease (COPD) and addresses this within five main study chapters. The aims and structure of this thesis are outlined on the following page along with the four key hypotheses that form the basis of this work. Collectively these studies show that improved patient selection and the development of a more systematic referral pathway will improve standards of care and reduce inequalities in patients being considered for and receiving these important interventions.
Lung volume reduction (LVR) therapies represent a potentially life changing treatment option for carefully selected patients with severe emphysema who derive little symptomatic benefit from traditional management plans. However, selection criteria are unclear and no formal referral pathways currently exist. This means that the number of patients undergoing LVR treatment in the UK may be disproportionate to the number eligible and that many may be missing out on these important treatments.
At present, there are two procedures available to patients that fit specific eligibility criteria for LVR that are both recognised in national and international guidelines and have a large body of robust evidence proving their efficacy. These procedures are lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs). However, there is currently no published data that directly compares the two procedures to establish which is superior for those that have equipoise for either treatment.
The work presented in this thesis has the primary objective of improving outcomes and access to LVR interventions for people with Chronic Obstructive Pulmonary Disease (COPD) and addresses this within five main study chapters. The aims and structure of this thesis are outlined on the following page along with the four key hypotheses that form the basis of this work. Collectively these studies show that improved patient selection and the development of a more systematic referral pathway will improve standards of care and reduce inequalities in patients being considered for and receiving these important interventions.
Version
Open Access
Date Issued
2024-01
Date Awarded
2024-07
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Hopkinson, Nicholas
Quint, Jennifer
Kemp, Samuel
Harding, Sian
Sponsor
National Institute for Health Research (Great Britain)
Mobilise-D IMI
Grant Number
PB-PG-1014-35051
IMI-820820
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)