Too many COPD patients denied rehabilitation

Pulmonary rehabilitation provides substantial health benefits for patients with Chronic Obstructive Pulmonary Disease (COPD), yet many people are waiting too long for treatment.

A new report from the Royal College of Physicians (RCP) shows that while there are significant health benefits associated with completion of pulmonary rehabilitation (PR) only 60% of people with COPD referred for RP were enrolled to an appropriate programme within 90 days.

And more than a third (38%) do not complete the treatment course once assessed. In addition, conduct of routine exercise assessments were not performed according to accepted standards in over 50% of patients.

The College says PR is an accepted standard of care for people with COPD and its lack of availability or a lack of referral can affect the quality of care for patients. PR is one of the few therapies that has shown to reduce patients’ time spent in hospital and it is a cost-effective treatment for COPD. Therefore, PR programmes should be a high priority for national and local health policymakers.

Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and a consultant respiratory physician, said: "The audit demonstrates the substantial health benefits received by people who complete PR. I hope the findings of this report and other PR audit reports will widen access to PR services and in turn, improve care for people with COPD. Patients and commissioners can also now begin to use these results in a practical way to understand the quality of their local services."

The report does highlights some important improvements to services, with 84% now providing a written discharge exercise plan compared to only 65% in 2015, and more services now have a standard operating procedure detailing local policies (84% in 2017, compared with 67% in 2015). Overall, the report reveals many areas of good quality PR treatment and for patients that do complete therapy meaningful improvements are seen in their quality of life.

As part of a range of recommendations the RCP has called for PR services to enrol 85% of patients referred for PR within 90 days; ensure all exercise assessments are performed to the recommended standards and aim for at least 70% of patients assessed to have completed PR.

The report also identifies the need for PR programmes to adapt their services to increase convenience and acceptability of programmes. This includes offering flexible start dates, increasing the provision of rolling programmes, and ensuring that the location at which PR is held is accessible to as many people as possible.

Inadequate funding exists for some PR services with 60% of PR services operating with a funding term of two years or less.