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Chronic obstructive pulmonary disease - Management
Basis for recommendation

These recommendations are based on the National Institute for Health and Clinical Excellence (NICE) clinical guideline Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010; NICE, 2010].

  • Evidence reviewed by NICE from a Cochrane systematic review suggests that pulmonary rehabilitation improves health-related quality of life and exercise capacity. NICE also found evidence that pulmonary rehabilitation is cost effective in the outpatient setting compared with usual care.
  • The recommendations to refer people who consider themselves functionally disabled by chronic obstructive pulmonary disease (COPD), and that this is equivalent to Medical Research Council breathlessness scale grade 3, are based on the expert opinion of the NICE guideline development group, augmenting a British Thoracic Society statement [British Thoracic Society, 2001].
  • Evidence reviewed by NICE from one systematic review and one subsequent randomized controlled trial found that, compared with usual care, people with an exacerbation of COPD who received pulmonary rehabilitation within 1 month of hospitalization had a significantly decreased risk of readmission to hospital and significantly improved exercise capacity and health-related quality of life.
  • The information that direct access from primary care is possible in some areas is derived from Consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England [DH, 2010].

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