Abstract
Background: COPD is a heterogeneous disorder. We developed a multidisciplinary evaluation scheme to identify patients with COPD who may benefit from phenotype-specific therapy. Methods: Our team of general and interventional pulmonologists, thoracic surgeons, radiologists, respiratory therapists, and advanced practice nurses meets monthly to discuss patients with advanced COPD. For each patient, pulmonary function tests, imaging, and other pertinent data are reviewed. Emphysema is assessed visually and by quantitative computed tomography modalities. A consensus is sought for medical, bronchoscopic, and/or surgical treatments and recommendations are relayed to the referring physician. Results: The multidisciplinary team reviewed 510 cases between November 2015 and December 2022. Eighty-five of 510 subjects were found to be appropriate candidates for lung-volume-reduction surgery and 36 underwent the procedure. Subjects in the post-multidisciplinary evaluation cohort experienced improvement in mean ± SD FEV(1) of 0.23 ± 0.38 L (P = .52) and mean ± SD reduction in residual volume by 0.78 ± 0.98 L (P = .09) 6 months after surgery, which was similar to the improvements in pre-multidisciplinary evaluation subjects (P = .52 and P = .09, respectively). Of the 202 subjects referred for bronchoscopic lung volume reduction, 28 underwent the procedure. Mean ± SD improvement in FEV(1) was 0.14 ± 0.18 L and mean ± SD reduction in residual volume was 0.68 ± 0.80 L (P = .002 and P = .001, respectively) at 6 months after the procedure. Most subjects were not suitable candidates for lung volume reduction due to anatomical, physiologic, or phenotypical exclusions. Management was found to be optimal in the majority of subjects who were not candidates for lung volume reduction (53.7%). A survey of meeting attendees indicated high confidence in managing these patients with a high likelihood of changing management decisions after multidisciplinary discussion. Conclusions: Most symptomatic subjects with advanced COPD were not candidates for lung-volume-reduction interventions. There is an unmet need for novel therapeutic options in this population. The multidisciplinary evaluation consensus recommendations provided assurance and guidance to clinicians.