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Advanced emphysema — SCE Respiratory MCQ

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HardCOPDAdvanced emphysemaSCE Respiratory

A 63-year-old man has severe heterogeneous upper-lobe emphysema despite optimal inhaled therapy and pulmonary rehabilitation. FEV1 is 31% predicted, RV is 215% predicted and TLCO is 34% predicted. CT fissure analysis suggests absent collateral ventilation and he remains breathless walking 100 metres. What is the most appropriate management?

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Correct answer: C — Refer for bronchoscopic lung volume reduction valve assessment

In carefully selected emphysema with hyperinflation, heterogeneous target lobe disease and absent collateral ventilation, endobronchial valve assessment is appropriate. CPAP treats sleep-disordered breathing rather than emphysema hyperinflation. Colistin and oral prednisolone do not address the physiological target and would add avoidable harm.

Reference: NICE IPG600; NICE NG115; BTS COPD Specialist Care guidance