P42 Effect of structured review of COPD patients referred for pulmonary rehabilitation; does this improve access to lung volume reduction?

Aim To assess the impact of virtual consultant review of COPD patients referred to pulmonary rehabilitation (PR), with reference to lung volume reduction suitability (LVR). Introduction NICE recommends that COPD patients that have completed PR, but continue to experience breathlessness affecting quality of life and meet certain criteria should be considered for LVR.1 However, whose responsibility this should be is not clear.2 Methods Notes and imaging of 100 consecutive COPD patients, referred for PR (one provider), were reviewed by one clinician regarding suitability for further assessment. Identified patients were offered out-patient appointments (OPA). From January 2019-November 2019 patients were reviewed on completion (40 patients). From November 2019- onwards reviews were on commencing PR (60 patients). Sources of data were clinical records and PACS radiology. Results The cohort was 52%/48% female/male. Mean age 68 years. Mean FEV1 57% (range 134% to 22%). Using NICE grades of airflow obstruction (AFO), 14% had mild AFO, 47% moderate AFO, 31% severe AFO and 8% very severe AFO. A subjective assessment of degree of hyperinflation on CXR was made; 45% had no hyperinflation, 25% had mild hyperinflation and 30% had significant hyperinflation. 54% had an existing CT; 19% had no emphysema, 57% had some emphysema, and 24% had severe emphysema. 28 patients were offered OPA. Following further assessment, 6 were suitable for referral to a hyperinflation service. To date one successful procedure has been performed and 3 patients are awaiting procedures (figure 1). 11 patients suitable for LVR on radiology and physiology were not referred due to too good functional levels, co-morbidities including mental health, and continued smoking. Conclusion Embedding assessment for potential LVR within PR is an efficient process and is likely to lead to more patients being referred for a treatment that can improve quality of life. References National Institute for Health and Care Excellence. nice.org.uk. [Online].; 2019 [cited 2020 August 17. Available from: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations. Dr Jo Congleton. Lung volume in COPD: when less is more. Drug and Therapeutics Bulletin. 2020 March; 58(4): 50.