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Chronic obstructive pulmonary disease - Management
When should I refer a person with COPD for pulmonary rehabilitation?
- Refer for pulmonary rehabilitation if the person considers themselves functionally disabled by chronic obstructive pulmonary disease (usually Medical Research Council dyspnoea scale grade 3 or above), or has had a recent hospitalization for an acute exacerbation.
- Availability and content vary. Most programmes are hospital based, and referral to a specialist respiratory unit may be needed to access services. However, direct access from primary care is possible in some areas.
- Inform the person that pulmonary rehabilitation improves quality of life and exercise capacity, and reduces breathlessness. However, commitment is required to gain these benefits.
- Programmes usually involve 2–3 sessions/week and last for 6–12 weeks.
- It is recommended that the rehabilitation process should involve physical training; disease education; and nutritional, psychological, and behavioural interventions tailored to the individual's needs. The aim is to optimize the person's physical and social performance, and to try to break the cycle of worsening breathlessness, reduced physical activity, and reduced fitness.
- Do not refer for pulmonary rehabilitation people who cannot walk, have unstable angina, or have had a recent myocardial infarction.
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