The Pulmonary rehabilitation: Beyond breathing better report from the Royal College of Physicians (RCP) National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme reveals that people who complete a full pulmonary rehabilitation programme are much less likely to be admitted to hospital than those who do not.
The COPD pulmonary rehabilitation (PR) report demonstrates that 76% of people who completed their PR course avoided hospital admission within 6 months after their initial assessment, compared to 62.1% who did not.
The report also reveals that people who were in hospital and who did not complete their PR course within 6 months after their initial assessment spent twice as long in hospital (9.6 days in 6 months) compared to those who were also admitted and did complete a course (4.8 days in 6 months).
COPD is the fifth biggest killer in the UK and the only major cause of death that is on the increase. It is responsible for 5% of annual deaths globally.
Pulmonary rehabilitation: Beyond breathing better covers the third part of the COPD PR audit, reviewing patients’ hospital admissions and mortality following assessment for PR for 7,135 people across 195 English PR services. It echoes the results from the previous audits: that PR gives substantial health benefits to those who complete treatment, however, many people do not complete their entire programme.
The report also found that mortality was higher in people who did not complete PR – within 3 months 1.6% of people had died compared to 0.1% who had completed PR treatment and within 6 months 3.2% of patients had died compared to 0.5% who had completed PR treatment.
The RCP has called for healthcare providers and commissioners to be aware of the substantial health benefits of completing PR, and the variety of reasons that may lead to patients not completing PR, including transport and access issues, as well as other illnesses.
The report states the need, therefore, for PR programmes to adapt their offering to increase convenience and acceptability of programmes. This includes:
- offering flexible start dates
- increasing the provision of rolling programmes
- ensuring that the location at which PR is held is as accessible as possible, to as many people as possible.
Main recommendations
- Commissioners and providers should ensure that robust referral pathways for PR are in place and that PR programmes have sufficient capacity to assess and enrol all eligible people.
- Healthcare providers should work with patient support organisations and charities to make patients and the public aware of the benefits of attending and completing PR so to encourage patient referral.
- Referrers and patients should be provided with up-to-date and clear written information about the benefits of attending and completing PR.
- Commissioners should incentivise providers to enrol a higher proportion of patients discharged from hospital.
Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and a consultant respiratory physician, said:
The audit demonstrates substantial health benefits received by people who complete PR. We know that PR is the most effective treatment for the symptoms people experience with COPD, and that it improves their quality of life and it is safe. Completing PR can reduce demands on the NHS, by helping people to manage their condition and thereby reducing risk of hospital admission.
I hope the findings of this PR audit report will widen access to PR services, and improve care for people with COPD.
Dr Lisa Davies, consultant respiratory physician and chair of the British Thoracic Society’s board of trustees, said:
The results of this comprehensive audit show just how beneficial pulmonary rehabilitation can be to people living with COPD. The treatment is a real ‘win-win’ option – offering excellent clinical outcomes in terms of reduced hospital readmissions, shorter lengths of hospital stay and lower mortality rates, whilst also being a very efficient use of NHS resources.
We encourage all clinicians to ensure they're referring patients for pulmonary rehabilitation where appropriate – and we urge commissioners to make sure there is sufficient service capacity in place to meet demand. The benefits are clear for all to see – let’s make sure this highly effective treatment is always available where needed.
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 National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and led by the RCP, working closely with stakeholders, including the British Thoracic Society (BTS), the Primary Care Respiratory Society UK (PCRS-UK), the British Lung Foundation (BLF) and the Royal College of General Practitioners (RCGP).
