Evidence for pulmonary rehab ‘uncontestable’

UK experts have welcomed the recent addition of pulmonary rehabilitation to UK COPD guidelines, saying the scientific evidence for its benefit is now ‘uncontestable’.

Its recognition as best practice in updated National Institute for Health and Care Excellence (NICE) guidelines means the provision of pulmonary rehabilitation for COPD patients was now endorsed in all national and international COPD treatment guidelines.

Writing in a comment published in the Lancet Respiratory Medicine Michael Steiner and Michael Roberts from the Centre for Exercise and Rehabilitation Science and The Institute for Lung Health at the Leicester Respiratory Biomedical Research Unit in the UK cautioned that the translation of scientific evidence and guidance documents into effective clinical practice was “not a given”.

“Pulmonary rehabilitation is a complex intervention that includes exercise therapy, disease education, behaviour change, and psychological support,” they wrote.

However a recent audit of UK clinical outcomes confirmed substantial and clinically important benefits bequeathed by pulmonary rehabilitation to patients who complete the treatment, they said.

The size of the benefits was in line with those seen in clinical trials, with most patients achieving changes in exercise performance and health status above accepted thresholds for important change, they noted in a Comment published in Lancet Respiratory Medicine.

However, the audit was also in line with published data indicating that substantial numbers of patients referred for pulmonary rehabilitation either do not attend an initial assessment (31% of those referred) or do not complete treatment (40% of those assessed).

Referral for pulmonary rehabilitation needs to move to the top of the agenda in discussions of treatment options with patients with COPD and other chronic respiratory diseases.

Routes of referral need to be streamlined and straightforward, they said.

“There is also a message to patients and patient groups. Pulmonary rehabilitation is demanding on patients’ time and effort but the audit confirms just how effective it can be if individuals adhere to the rehabilitation course,” they said.

In Australia a proposal currently under consideration by the Medicare Services Advisory Committee will allow GPs to refer patients with chronic lung disease to an eight-week course of pulmonary rehabilitation.

Eligible patients will include those diagnosed with COPD, bronchiectasis, interstitial lung diseases, and lung cancer who are managed in the community and have had their pharmacotherapy optimised.

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