Short summary

Bronchial Lung Volume Reduction using valves has been implemented at OUH as a palliative, dyspnea reducing treatment in patients with severe emphysema. This project is established to assess MDT decissions and outcome of BLVR.

Rationale

Chronic Obstructive Pulmonary Disease (COPD) is common chronic disease and is a part of the top 3 leading causes of death worldwide. In 2012 COPD accounted for 6% of all deaths worldwide. COPD is associated with significant comorbidities, which increases its morbidity and mortality. Due to an ageing public the burden of COPD will increase in the future.

COPD is characterized by respiratory symptoms and airflow limitations. The patients experience symptoms such as dyspnoea, cough and/or sputum production. Some COPD patients have a persisting cough and sputum production for at least 3 months which is called chronic bronchitis. The airflow limitations is due to a mix of small airway obstruction and the destruction of the alveoli of the lung (called emphysema). Emphysema leads to decreased gas-exchanging surfaces of the lung and hyperinflation of the lung because of increased residual volume.

One treatment regime of the hyperinflation caused by COPD is lunge volume reduction, which is recommended by GOLD guidelines (evidence A) as well as NICE to selected patients. GOLD guidelines state that in select patients with advanced emphysema, bronchoscopic interventions reduce end-expiratory lung volume and improve exercise tolerance, health status and lung function at 6-12 months following treatment.

The purpose of BLVR is to reduce the hyperinflation by achieving atelectasis of lung lobes that have been affected by emphysema. BLVR is possible on patients with heterogeneous and homogenous emphysema. The patients that achieve total atelectasis of a lung lobe experience greater outcomes. Earlier studies has indicated that there is a statistically significant difference between patients' outcome of BLVR based on their base line lung function. The group that developed complete atelectasis instead of partial or no atelectasis experienced at 3 months statistically significant improvement in several parameters.

The setup of bronchoscopic intervention in the Danish healthcare system is based on endobronchial valve placement a selected group of patients. The initial assessment of patients takes place at hospitals in all of Denmark, who refer the patients to bronchoscopic lung volume reduction multidisciplinary team conference (BLVR-MDT) at University Hospitals. The BLVR-MDT group consists of a pulmonary specialist, radiologist, thoracic surgeon and nuclear medicine physician. Eligable patients are referred to the Thoracic Surgery department. In Denmark BLVR assessment is centralized at three sites: Odense University Hospital (OUH), Aarhus University Hospital and Aalborg University Hospital and Rigshospitalet.

One of the challenges with lung volume reduction is the strict selection and assessment of potential candidates.

Purpose: The aim of this study is primarily to assess patient outcome. Secondly, the study can reveal organizational and patient challenges, for future adjusting.

Outcomes: Changes in lungfunction (FEV1; FVC; TLC, RV, Diffusion), patients' symptoms, 6MWT, atelectasis, morbidity, mortality.

Description of the cohort

All patients with COPD and emphysema predominance referred either from other hospitals in the region or in house for evaluation of BLVR eligibility at the Respiratory Department.

Data and biological material

Basline data: age, sex, diagnoses (emphysema and comorbidities), patient journal data including data on High Resolution CT-sans for the chest.