Pulmonary rehab should be offered to all COPD patients

By Mardi Chapman

25 Mar 2017

All COPD patients should be offered pulmonary rehabilitation regardless of their disease severity, according to the first-ever pulmonary rehabilitation guidelines for Australia and New Zealand.

The evidence-based guidelines launched at the the TSANZSRS meeting in Canberra were drawn up following a systematic review of over 275 clinical trials, complement existing local resources such as Lung Foundation Australia’s Pulmonary Rehabilitation Toolkit.

Professor Jennifer Alison, chair of the pulmonary rehabilitation guidelines panel, told the limbic the evidence was ‘largely in’ regarding the effectiveness of pulmonary rehabilitation.

Pulmonary rehabilitation was not only effective for patients with COPD but also for those with bronchiectasis and interstitial lung disease. It was also recommended for pulmonary hypertension if provided in a specialist centre.

“There is a high level of evidence that pulmonary rehabilitation can improve quality of life and exercise capacity in patients. There is also some evidence, but not as strong, that pulmonary rehabilitation can reduce hospital admissions and readmission following acute exacerbations.”

However some questions remain to be answered about optimal design and delivery of programs.

For example, there have been no direct comparisons between the typical eight-week programs offered in Australia and programs of longer duration, Professor Alison said.

Similarly, while an education component of pulmonary rehabilitation is important to drive the necessary behaviour change, it may not need to be delivered in a structured form.

“Pulmonary rehabilitation should be offered irrespective of the availability of structured multidisciplinary education. For example, if staff such as psychologists or dietitians are not available, that should not stop the pulmonary rehabilitation program going ahead.”

Professor Alison said a key message was that all patients with COPD, regardless of their disease severity, should be offered pulmonary rehabilitation.

“No one is too sick or too well to benefit. They should all be given the option to learn about their disease, sent for an assessment and then the program can be tailored to their needs.”

The guidelines make a recommendation for referral to home-based or community programs if they can be offered at the same frequency and intensity as the hospital programs.

She said the availability of programs could be expected to improve if the proposal for dedicated MBS items was successful.

“In reality, the drivers of access to these programs are financial. The Independent Hospital Pricing Authority provides funding for pulmonary rehabilitation in hospitals but there is no such facility in primary care.”

Professor Alison said there was as yet no clear model to protect or guarantee maintenance of gain following pulmonary rehabilitation.

However patients could access ongoing exercise training and support via Lung Foundation Australia’s Lungs in Action program.

Related stories: 

Evidence for pulmonary rehab reflected in updated COPD-X guidelines

Simple home-based rehab offers hope for COPD patients missing out on care

Lung Foundation push for pulmonary rehab MBS item

 

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