Intended for healthcare professionals


NHS offers lung volume reduction procedures for severe emphysema

BMJ 2020; 371 doi: (Published 05 November 2020) Cite this as: BMJ 2020;371:m4308
  1. Elisabeth Mahase
  1. The BMJ

Lung volume reduction is being made available for adults in England who have severe emphysema, after NHS England approved the treatment. An estimated 660 people in England are currently suitable for the treatment, and this number could increase to around 1200 over the next five years.

Emphysema is one of the presentations of chronic obstructive pulmonary disease (COPD). It is caused by inhaling noxious materials, such as tobacco smoke, leading to the breakdown of elastic tissue in the lung. Around 1.1 million people in England have a COPD diagnosis.

Lung volume reduction is an approach that removes the most damaged areas of the lung so that the healthier parts can work better. By removing the enlarged lung air spaces that occur in emphysema, less air is trapped, making breathing more efficient and comfortable.

There are currently two procedures for lung volume reduction. One involves surgery to cut out part of the diseased lung; the other approach is to insert a valve or valves into the airways to stop air from getting into the diseased parts of the lungs.

However, although COPD is very common, only a very small proportion of patients are likely to meet the criteria to be assessed for lung volume reduction. The referral criteria include being a non-smoker for at least four months and having evidence of “symptomatic hyperinflation due to emphysema with impaired quality of life.”

People may be excluded if they have severe comorbidities such as renal, hepatic, or cardiac failure or another chronic respiratory disease such as pulmonary fibrosis. Severe progressive disease including disseminated malignancy, as well as severe pulmonary hypertension, could also make a person unsuitable for referral.

A beacon of hope

In its clinical commissioning policy document NHS England said that it had “enough evidence to consider making treatments with both surgery and endobronchial duckbill valves available in centres with an experienced multidisciplinary clinical team.”1

The document added that “coils, umbrella-type valves and other novel technologies should remain within the research setting” and that patients with emphysema who are not suitable for surgery or valves may be able to access ongoing research studies with these alternative developing therapies through a newly proposed pathway.

Alison Cook, chair of the Taskforce for Lung Health and director of external affairs at Asthma UK and the British Lung Foundation, said, “We are delighted that lung volume reduction surgery will now be considered a priority treatment by NHS England, creating the opportunity for thousands of people who have been severely limited by their lung condition to breathe better, for longer.

“More people than ever before will now have access to this lifechanging treatment, and this decision is a beacon of hope to the many patients who have struggled to access care and support during the pandemic, showing that progress is still being made to support people living with lung conditions across the country.”