Three clinical criteria. If all three are met and the patient has stopped smoking, they are a candidate for formal lung volume reduction assessment. Mr Okiror arranges the full workup — echocardiogram, HRCT, quantitative V/Q SPECT, six-minute walk test, pulmonary rehabilitation assessment, fissure and collateral ventilation assessment for valve candidacy (StratX®, Chartis), (± blood gas) — and MDT discussion including the Harefield lung transplant team.
Last reviewed: May 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
*StratX® CT fissure analysis and Chartis collateral ventilation assessment determine endobronchial valve (bLVR) candidacy. LVRS does not require fissure integrity.
A brief referral letter with recent spirometry and CT chest report is sufficient. Static lung volumes, fissure analysis, and collateral ventilation assessments are arranged as part of the workup — they are not required before referral. Clinic letters to GPs electronically within 2 working days.
Jo Mitchelson, PA
020 7952 2882 · pa@lungsurgeon.co.uk
Private appointments at London Bridge Hospital within 2–3 working days. NHS referrals through Guy’s and St Thomas’.
Based on the answers above, this patient does not currently meet the standard screening criteria for lung volume reduction assessment. This does not necessarily mean there are no surgical options.
If the patient has a dominant bulla on CT — causing breathlessness, recurrent pneumothorax, infection, haemoptysis, chest pain, or suspected cancer — they may be a candidate for bullectomy, which has different indications and does not require the hyperinflation thresholds above.
If you are uncertain, a referral for specialist assessment is still appropriate — the MDT determines eligibility, not the screening criteria alone.
Jo Mitchelson, PA
The clinical criteria are met, but confirmed smoking cessation is a prerequisite for lung volume reduction assessment. Once the patient has stopped smoking, they would meet the screening criteria for formal assessment.
Referral is still appropriate once cessation is confirmed. Mr Okiror’s team can advise on timing.
Jo Mitchelson, PA
Different pathway
Patients with a dominant bulla do not need to meet hyperinflation thresholds. Bullectomy has its own indications — breathlessness from a compressive bulla, pneumothorax, infection, haemoptysis, chest pain, suspected cancer in or adjacent to a bulla, or enlarging bulla on serial imaging. Bullectomy page →
For the full evidence base, selection framework, trial data, and MDT model: Emphysema Surgery in 2026 — A UK Surgeon’s Perspective →
For the patient-facing emphysema page: Emphysema Treatment London →
Private appointments at London Bridge Hospital within 2–3 working days. Sole operator for EBV and LVRS at London Bridge Hospital and at Guy’s and St Thomas’. 100+ combined interventions since 2019.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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