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Chronic obstructive pulmonary disease

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

Clinical lead

Dr Nicholas Hopkinson
Location: Royal Brompton Hospital, South Block, Fulham Road, SW3 6NP      

Administrator
Tel: 020 7349 7775
Fax:  020 7349 7778

 

COPD specialist physiotherapist Bhavin Mehta (bleep 1050)


Chest physicians 

Dr Nicholas Hopkinson

Professor Michael Polkey

Dr Matthew Hind

Dr Jenni Quint 

Dr Omar Usmani

Dr Sam Kemp

 

Radiologist

Dr Dennis Carr

 

Thoracic surgeons

Mr Simon Jordan


Download the COPD referral form here



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 improves 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.



[ Zoom ]
COPD referral table
How to refer for a lung volume reduction procedure

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



[ Zoom ]
COPD pyramid
The pyramid of value for COPD interventions developed by the London Respiratory Network with the London School of Economics

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




Royal Brompton

Sydney Street,
London SW3 6NP
Tel: +44 (0)20 7352 8121

Harefield

Find out more about the Trust's research into COPD