The National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme’s Pulmonary Rehabilitation (PR) Report reveals substantial health benefits received by patients who complete PR treatment yet many patients are not being referred, and many patients (40%) find it difficult to complete the PR programme.
COPD is the collective term for emphysema and chronic bronchitis, and it is mainly caused by smoking. People with COPD have breathing difficulties, which can affect the quality of their everyday life and prevent normal physical activity. PR is a combination of exercises to improve physical activity and fitness, together with advice and education about self-care: all of which help patients with COPD to cope with this long term medical condition.
The report also shows that over a third of patients (37%) in England and Wales are waiting longer than the 3 months recommended in the British Thoracic Society (BTS) quality standards.
The report entitled Pulmonary Rehabilitation: Steps to breathe better covers the second part of the COPD PR audit, reviewing the quality of care received by 7,413 patients across 210 PR services in the primary, secondary and community care sectors.
Overall, the report reveals many areas of good quality PR treatment for COPD patients, including widespread provision of walking (95%), cycle (70%) and aerobic and resistance exercise therapy (89%). However, not all patients are being provided with an on-going individual exercise plan.
There remain significant variations in waiting times and quality of care when patients attend PR, and unacceptably long waits for treatment are more common when PR is given as part of a group because patients have to wait until the start of the next scheduled programme.
The report highlights the need for greater awareness of the benefits of PR in primary and secondary care. It also urges commissioners and providers to ensure that all patients receive an offer to start PR treatment within the recommended 3 months following their referral.
Katy Beckford, who represented ARNS on the Pulmonary Rehabilitation Development Group said “Pulmonary rehabilitation is know to have significant health benefits with respiratory disease but many patients are still not being referred, are not accessing it or are not completing the course”
The key findings and recommendations are set against BTS quality standards for PR. The full COPD PR audit report can be found at: www.rcplondon.ac.uk/COPD
Other key findings
- There is widespread provision of walking (95%), cycle (70%) and aerobic and resistance exercise training (89%).
- Most patients (74%) were provided with a written, on-going individualised exercise plan following discharge. However, this means that almost one-third (26%) of patients who attend a discharge assessment are not given an individualised plan.
- Significant numbers of patients who attend a PR assessment do not complete the treatment (40%).
- Patients that do complete PR, on average, show substantial improvements in quality of life and ability to exercise.
- Patients with a full range of self-reported exercise limitation were assessed and enrolled to PR. However, only 9% of patients who have the most severe disability were enrolled to PR.
