Recommendation for NHSScotland

All patients referred to secondary care who have severe or very severe emphysema, and significant disability despite optimal medical management, should undergo a detailed assessment by a multidisciplinary team to determine eligibility for lung volume reduction.

Endobronchial valves should be available to all eligible patients, with procedures consolidated within a small number of centres via a unified national referral pathway to ensure equity of access. Patients should not be considered for endobronchial lung volume reduction if they have collateral ventilation or if they lack suitable target areas within the lungs.

Individual patient- and procedure-associated risk must be discussed with the patient as part of a shared decision on endobronchial lung volume reduction.

The cost effectiveness of endobronchial valve implantation remains uncertain for the Zephyr® valve and there are no cost effectiveness data for the Spiration® valve. Patient outcome data for all valve procedures should be collected and made available to inform future economic analyses.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) recommendation.

What were we asked to look at?

A manufacturer of endobronchial valves (Pulmonx International) asked us to look at the evidence on the use of endobronchial valves to reduce lung volume in patients with severe or very severe emphysema who continue to experience significant emphysema-associated disability despite optimal medical management. Scottish consultant thoracic surgeons confirmed the relevance of this topic to NHSScotland.

Why is this important?

Emphysema and chronic obstructive pulmonary disease (COPD) are chronic, progressive, and ultimately fatal, diseases of the lungs. Emphysema is one of two conditions that are classed as COPD, the other being chronic bronchitis. Emphysema can exist without chronic bronchitis as a distinct respiratory condition. Patients with COPD can have predominantly emphysema, predominantly chronic bronchitis, or both. Chronic obstructive pulmonary disease is the second most common lung
disease in the UK.

Treatments for emphysema/COPD include lifestyle modification, pulmonary rehabilitation, and medical therapies. A proportion of patients with severe or very severe emphysema/COPD that continues to worsen despite optimal medical management require surgical intervention to reduce the volume of their damaged lungs. Lung volume reduction surgery is an invasive, palliative procedure involving excision of 20-40% of the volume of each affected lung1. Endobronchial valve implantation offers a less invasive option for lung volume reduction.

Referred by

Pulmonx International