Home » Projects » Pulmonary Rehabilitation: Steps to breathe better

Pulmonary Rehabilitation: Steps to breathe better

This is the second of the COPD Pulmonary Rehabilitation audit reports, published as part of the National COPD Audit Programme, detailing national data relating to Pulmonary Rehabilitation delivered in England and Wales. It also documents attainment against relevant Pulmonary Rehabilitation guidelines and quality standards as published by the British Thoracic Society (BTS) in 2013 and 2014.

Key recommendations

These recommendations are directed collectively to commissioners, provider organisations, referrers for PR and to PR practitioners themselves. They are also relevant to patients, patient support groups and voluntary organisations. Implementing these recommendations will require discussions between commissioners and providers, and we suggest that the findings of the audit are considered promptly at board level in these organisations so that these discussions are rapidly initiated. Commissioners and providers should ensure they are working closely with patients, carers and patient representatives when discussing and implementing these recommendations. This report identifies two broad areas for improvement: firstly action to improve referral and access to PR; and secondly action to improve the quality of treatment when patients attend PR.

  • Improving access to PR
    • Providers and commissioners should ensure that robust referral pathways for PR are in place and that PR programmes have sufficient capacity to assess and enrol all patients within 3 months of receipt of referral.
    • Referral pathways should be developed to ensure all patients hospitalised for acute exacerbations of COPD are offered referral for PR and that those who take up this offer are enrolled within 1 month of discharge.
    • Providers and commissioners should work together to make referrers (including those working in general practice and community services) and patients fully aware of the benefits of PR, to encourage referral.
    • PR programmes should take steps to ensure their services are sufficiently flexible to encourage patients who are referred for PR to complete treatment.
  • Improving the care provided by PR programmes
    • a. All PR programmes should examine and compare their local data with accepted thresholds for clinically important changes in the clinical outcomes of PR and with the national picture. For all programmes, this should prompt the development of a local plan aimed at improving the quality of the service provided.
    • PR programmes locally should review their processes to ensure all patients attending a discharge assessment for PR are provided with a written, individualised plan for ongoing exercise.
    • c. PR programmes locally should review their processes to ensure all outcome assessments are performed to acceptable technical standards (4).

The report is relevant to anyone with an interest in COPD. It provides a comprehensive picture of Pulmonary Rehabilitation services, and will enable lay people, as well as experts, to understand how COPD services function currently, and where change needs to occur.

The information, key findings and recommendations outlined in the report are designed to provide readers with a basis for identifying areas in need of change and to facilitate development of improvement programmes that are relevant not only to Pulmonary Rehabilitation programmes but also to commissioners and policymakers.

Who's involved


  • Royal College of Physicians
  • British Thoracic Society
  • Royal College of General Practitioners
  • Primary Care Respiratory Society
  • British Lung Foundation
  • Healthcare Quality Improvement Partnership