NICE recommends pulmonary rehabilitation programmes for patients with COPD

Patients with stable chronic obstructive pulmonary disease (COPD) and exercise limitation due to breathlessness should be referred to a pulmonary rehabilitation programme, the National Institute for Health and Care Excellence (NICE) has recommended.

The updated quality standard from NICE1 also recommended that patients admitted to hospital for an acute exacerbation of COPD should start a pulmonary rehabilitation programme within four weeks of discharge. NICE said that this reduces the short term risk of hospital readmission, as well as improving the quality of life and the short term exercise capacity of people with COPD.

A pulmonary rehabilitation programme is a multidisciplinary programme of care for people with chronic respiratory impairment that includes exercises, information, diet advice, and support tailored to the individual patient’s needs. Programmes should last at least six weeks and should include at least two supervised sessions a week, NICE said.

The British Lung Foundation welcomed the inclusion of pulmonary rehabilitation as best practice for the first time. Mike McKevitt, head of patient services, commented, “Pulmonary rehabilitation is a cost effective route to improving a patient’s health and quality of life, and we hope that these standards will encourage greater patient access and compliance with pulmonary rehabilitation across the UK.”

An estimated three million people in the United Kingdom have COPD, of whom two million have not had it diagnosed. People are at increased risk of COPD if they are a current or ex-smoker or if they have often been exposed to harmful fumes, dust, or chemicals. Its prevalence increases with age, and the condition is closely associated with levels of deprivation.

The quality standard said that patients aged over 35 presenting with a risk factor and one or more symptoms of COPD should have a diagnosis confirmed by post-bronchodilator spirometry. To ensure early diagnosis the spirometry should be done in primary care, it added.

Other recommendations are that patients who have an inhaler prescribed should have their inhaler technique assessed when starting treatment and then regularly as treatment progresses. And people with stable COPD and a persistent resting stable oxygen saturation level of 92% or lower should have their arterial blood gases measured to assess whether they need long term oxygen therapy.

Patients with COPD who need emergency oxygen because of a sudden flare-up of symptoms should have their oxygen saturation levels maintained at 88-92%, the quality standard said. In some people, uncontrolled oxygen therapy may reduce the depth and frequency of breathing, leading to a rise in blood carbon dioxide levels and a fall in the blood pH level.

• Download figure
• Open in new tab
• Download powerpoint