Editor – We read the article on lung volume reduction surgery(LVRS) by SJ Clark et al (Clin Med April 2014 pp 122–7) withgreat interest.The data reported – relatively small numbers of patientscarefully selected and treated over a 12-year period within ahighly developed multidisciplinary service for patients withchronic obstructive pulmonary disease (COPD) – may not berepresentative of the surgical mortality and complication ratesachievable if all of the 16,000 individuals that are potentiallyeligible for LVRS undergo this procedure across the UK.However, the data is compelling and does serve to highlight thesafety, availability and surprisingly poor uptake for a proceduretargeted at a group of patients where, until relatively recently,interventions carrying a survival benefi t have been lacking.The question as to why so few people are undergoing LVRSis a critical one. The authors hypothesise that perceivedconcerns regarding surgical mortality and morbidity may becontributing to low LVRS rates, and their study looks to addressthis hypothesis. We feel that although British Thoracic Societyguidelines recommend confi rmation of bullous lung diseasein primary care followed by referral to thoracic surgical units,1there seems to be a lack of awareness of LVRS among cliniciansworking in the community where these patients are increasinglybeing managed. Additionally, the long-recognised therapeuticnihilism among clinicians treating patients with COPD, andCOPD patients themselves, may be a bigger factor.
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