Pulmonary rehab for COPD is valued by patients with the disease,but they experience barriers after the programme has finished

University of Oxford | July 2018 |COPD patients’ quality of life improved by socialising and regular exercise

People with COPD (Common Obstructive Pulmonary Disease) may have better quality of life if they have access to health professionals, socialise with friends and take regular exercise, finds research from the University of Oxford and University of Lincoln (via University of Oxford). 


The journal Primary Care Respiratory Medicines, study shows that regular contact with healthcare professionals, including feedback about progress and achievements, is important to motivate people with COPD to be physically active following pulmonary rehabilitation-a treatment of exercise and education in the NHS, which can improve fitness, reduce shortness of breath and enhance quality of life in people with COPD. The research team also found that social interaction with peers fosters a sense of solidarity and support following rehabilitation. Regular exercise sessions also encourage the establishment of a routine.

The average treatment is 6-8 weeks and while patients with COPD report positive experiences and value support from health professionals during this  programme, this study found a number of impediments to remaining active after pulmonary rehabilitation including social isolation, restricted access to exercise sessions in the community, and symptoms of their condition such as breathlessness that evoked anxiety or fear and make them avoid activities.
Dr Arwel Jones, Research Fellow at the Lincoln Institute for Health at the University of Lincoln, UK said: ‘Being physically active is extremely important for people with COPD, however, people with the disease find it difficult to remain physically active once they have finished pulmonary rehabilitation.’ (Source: University of Oxford)

Press release:

University of Oxford COPD patients’ quality of life improved by socialising and regular exercise

University of Lincoln Better Social Support and Improved Access to Exercise Classes Could Help People with Lung Conditions Remain Active

The systematic review can be read in full from Nature


Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients’ perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD.

Full reference:

Robinson, H., Williams, V., Curtis, F., Bridle, C., & Jones, A. W. |2018 | Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies| NPJ primary care respiratory medicine| 28| 1 |19

COPD National Audit Programme

Health Quality Improvement Programme | April 2018 | National COPD Audit Programme COPD: Time to Integrate care 

The Health Quality Improvement Programme (HQIP) has published two relating to the National Chronic Obstructive Pulmonary Disease Audit.

Image source: hqip.org.uk

COPD: Time to integrate care

The report presents the results from a snapshot audit of the organisation and resourcing of COPD care that was undertaken in hospitals in England and Wales in the spring of 2017. The report makes a number of recommendations, among them the need to:

• reduce the rise in admissions, where it is possible to do so
• improve access to hospital- and community-based respiratory care (including over weekends)
• develop more effective cross-sector working and integration of COPD services.

The report can be downloaded from HQIP here

Health Quality Improvement Programme | April 2018 | National COPD Audit Programme: Pulmonary rehabilitation: An exercise in improvement 

COPD National report 2018: Pulmonary rehabilitation, an exercise in improvement

Pulmonary rehabilitation (PR) is one of the most effective and high value interventions for people suffering with COPD. This report presents the second round of both clinical and organisational PR audits, which follow the first rounds conducted in 2015.

copd audit
Image source: hqip.org.uk

The report summarises key findings, and priorities for quality improvement presented under three broad categories:

  • access to PR
  • quality of PR services
  • outcomes of treatment

It also highlights successes

  • rates of completion have improved marginally to 62% in 2017 compared with 59% reported in 2015
  • improvements in the provision of written discharge exercise plans (84% in 2017 versus 65% in 2015),
  • the assessment of muscle strength (27% in 2017 versus 15% in 2015) and in the numbers of programmes with a written standard operating procedure (84% in 2017 versus 67% in 2015).

The report can be downloaded from HQIP here 


Chronic obstructive pulmonary disease pathway

NHS RightCare has published RightCare Pathway: COPD.  This pathway defines the core components of an optimal service for people with chronic obstructive pulmonary disease (COPD).  It includes resources to support local health economise to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health.  It contains a number of key messages for commissioners.

Report highlights alarming level of readmission for COPD patients

COPD: Who cares when it matters most? | National Chronic Obstructive Pulmonary Disease Audit Programme

A new report from the Royal College of Physicians and the British Thoracic Society shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.

Image source: http://www.rcplondon.ac.uk

COPD: Who cares when it matters most?,  demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions.

The report also highlights improvements in the safety and efficiency of COPD care. The report shows that inpatient mortality has decreased from 7.9% in 2003 to 4.3% in 2014.

Fewer patients are dying after discharge from hospital. There has been a marked decrease in the average length of stay in hospital for acute exacerbation of COPD, which fell from 6 days to 4 days in the same period.

Recommendations to improve treatment and care of patients with COPD include:

  • early identification of individuals at risk of deterioration
  • careful assessment of patients with multiple healthcare needs and conditions
  • improved discharge planning, particularly for vulnerable and frail patients
  • the development of integrated approaches to COPD care.

Download the full report here

Long-Term Oxygen for COPD

Rothaus, L. Now@NEJM Blog. Published online: 27 October 2016

Image source: Now@NEJM

Two trials that were conducted in the 1970s showed that long-term treatment with supplemental oxygen reduced mortality among patients with chronic obstructive pulmonary disease (COPD) and severe resting hypoxemia. In the 1990s, two trials evaluated long-term treatment with supplemental oxygen in patients with COPD who had mild-to-moderate daytime hypoxemia; neither trial showed a mortality benefit, but both were underpowered to assess mortality. The effects of oxygen treatment on hospitalization, exercise performance, and quality of life are unclear. The Long-Term Oxygen Treatment Trial assessed the potential benefits of supplemental oxygen among patients with COPD and moderate resting desaturation or exercise-induced desaturation. In this trial, long-term supplemental oxygen treatment did not result in longer survival than no use of supplemental oxygen among patients with stable COPD and moderate resting desaturation (Spo2, 89 to 93%) or moderate exercise-induced desaturation. A new Original Article explains.

Clinical Pearl

What are the estimated oxygen-related costs for patients with COPD in the United States?

Medicare reimbursements for oxygen-related costs for patients with COPD exceeded $2 billion in 2011. If long-term treatment with supplemental oxygen reduces the incidence of COPD-related hospitalizations, increased use could be cost-effective. Reliable estimates of the number of prescriptions for supplemental oxygen that are written for the indication of exercise-induced desaturation are unavailable. Data suggest that many patients with advanced emphysema who are prescribed oxygen may not have severe resting hypoxemia.

Clinical Pearl

What Spo2 values (oxyhemoglobin saturation), as measured by pulse oximetry, are consistent with moderate resting desaturation and moderate exercise-induced desaturation?

In the Long-Term Oxygen Treatment Trial, a total of 14 regional clinical centers and their associated sites (a total of 47 centers) screened patients who had stable COPD and moderate resting desaturation (Spo2, 89 to 93%) or moderate exercise-induced desaturation (during the 6-minute walk test, Spo2 ≥80% for ≥5 minutes and <90% for ≥10 seconds).

Read the full overview here

Read the original research article here

Pulmonary Rehabilitation: Steps to breathe better

The National COPD Audit Programme has published Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015.

image source: http://www.rcplondon.ac.uk

This is the second COPD pulmonary rehabilitation audit report. Its recommendations are directed collectively to commissioners, provider organisations, referrers for pulmonary rehabilitation and to pulmonary rehabilitation practitioners themselves. The report identifies two broad areas for improvement: firstly action to improve referral and access to pulmonary rehabilitation; and secondly action to improve the quality of treatment when patients attend pulmonary rehabilitation.


New NICE Quality Statement: Chronic obstructive pulmonary disease in adults

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.
This quality standard covers the assessment, diagnosis and management of chronic obstructive pulmonary disease (COPD). It does not cover prevention, screening or case finding. For more information see the COPD topic overview.

This quality standard was previously called chronic obstructive pulmonary disease quality standard.

In February 2016, this quality standard was updated. A new statement on emergency oxygen during an exacerbation has been added and the other quality statements have been updated.

Read the full guidance here