Chronic obstructive pulmonary disease

COPD is a major cause of ill health in the UK affecting around one million people.

Overview

Chronic obstructive pulmonary disease (COPD) is an umbrella term covering chronic bronchitis, emphysema and alpha-one-antitrypsin deficiency, which can be caused by inhaling tobacco smoke or other noxious materials. It is a major cause of ill health in the UK with more than a million people diagnosed in England and Wales. Royal Brompton Hospital offers a world-class, multidisciplinary service to patients in both the local community and across the country.

Within the Trust, we have expertise in non-invasive ventilation (NIV), interventional bronchoscopy and surgical intervention, as well as the systemic manifestations, epidemiology and basic disease mechanisms of COPD.

Treatment

Lung volume reduction – surgical (LVRS) and bronchoscopic (BLVR)

Lung volume reduction, either surgical or bronchoscopic, has the potential to dramatically improve the condition of people with emphysema. LVRS has a grade A evidence base and is recommended in national and international guidelines for appropriately selected patients with poor exercise capacity and heterogeneous emphysema. LVRS is one of the few interventions that improve survival in COPD. Importantly, the morbidity associated with the procedure is much lower in modern practice than at the time of the National Emphysema Treatment Trial (NETT).

LVRS should be actively considered in all patients who are still limited following pulmonary rehabilitation (Medical Research Council (MRC) dyspnoea score of 4 or 5). 

The role of bronchoscopic techniques is evolving. There is now clear evidence that endobronchial valves are effective in selected patients with heterogeneous emphysema (similar criteria to LVRS). The department has been and remains involved in trials of techniques including lung volume reduction coils, bronchoscopic thermal vapour ablation (steam) and endobronchial vagal denervation. 

Advanced COPD multidisciplinary team meeting

A multidisciplinary team (MDT) meeting occurs weekly. Patients’ clinical histories, lung function and imaging are reviewed, with input from the thoracic surgical team, radiology and interventional bronchoscopy specialists.

All patients discussed in the MDT are evaluated for their eligibility for possible bronchoscopic therapies.

Referrals 

Referrals can be made:

Please complete a referral pro-forma as fully as possible. Referrals may be reviewed in the MDT meeting first to decide if the patient is likely to benefit. Specific requests for an initial MDT opinion are also welcome. 

There is sometimes uncertainty about who should be referred for consideration of a lung volume reduction procedure. The table to the right is a guide to aid referral. For questions about the referral pathway or what investigations are needed, please email COPD@rbht.nhs.uk

COPD rapid access clinic 

A COPD rapid access clinic is available for patients who live locally who require hospital specialist input. Direct booking of appointments is available through the NHS e-Referral Service. This clinic is provided by Dr Nicholas Hopkinson, Dr Omar Usmani and Dr Jenni Quint, and supported by specialist COPD physiotherapist, Bhavin Mehta.

Self-management strategies including inhaler technique and recognising exacerbations are emphasised, with priority given to ensuring the delivery of high-value care. 

Oxygen assessment, including ambulatory assessment, is available through this clinic as well as hypoxic challenge ('fitness to fly') testing.

The COPD service provides access to lung function, CT scanning, pulmonary rehabilitation, fitness-to-fly testing, smoking cessation, sleep studies and palliative care, and can be accessed via fax on 020 7349 7778.

Alpha-one-antitrypsin deficiency

Patients with this condition are seen in the Thursday morning clinic in parallel with the advanced COPD service. We have one of the largest cohorts in the UK and are part of the National Institute for Health Research (NIHR) rare disease collaboration. 

COPD clinic at Harefield Hospital

Clinic summary 

The severe COPD clinic at Harefield Hospital is a multidisciplinary consultant-led service that provides assessment and optimum clinical management for patients with COPD, who remain symptomatic despite maximum inhaler therapy. Referrals are welcome from both primary and secondary care colleagues. 

If appropriate, patients will be assessed for pulmonary rehabilitation, lung volume reduction surgery, experimental emphysema treatments such as bronchoscopic lung volume reduction procedures, prophylactic antibiotics, lung transplantation, domiciliary oxygen and non-invasive ventilation. The clinics are supported by clinical nurse and physiotherapy specialists, the Harefield pulmonary rehabilitation team, the home oxygen service, and the domiciliary non-invasive ventilation service.

Clinic days and times 

Mondays, Thursday afternoons, Friday afternoons

Clinical lead and clinical team 

Who should be referred? 

  • Presumed COPD, requiring a definitive diagnosis
  • Symptomatic COPD despite maximum inhaler therapy
  • COPD with respiratory failure
  • COPD with repeated exacerbations (two or more courses of antibiotics in past year)
  • Assessment for lung volume reduction surgery 

Meet the team

Clinical lead

Chest physicians

Radiologist

  • Dr Dennis Carr

Thoracic surgeon

COPD specialist physiotherapist

  • Bhavin Mehta (bleep 1050)

Administrator

Tel: 020 7349 7775

Fax: 020 7349 7778

Download the COPD referral form (PDF, 193KB)

Referral letters

Letters to be addressed to

Dr Man or Dr Natanek,
Department of Respiratory Medicine
Harefield Hospital
Hill End Road
Harefield
Middlesex
UB9 6JH

Letters can be faxed (safe haven) to 01895 828851

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