A Bill of “Rights” for patients with COPD: the “right” therapy for the “right” patient at the “right” time
- Correspondence to Dr L Nici, Department of Medicine, The Warren Alpert Medical School of Brown University, Associate Chief, Pulmonary and Critical Care Section, Providence Veterans Affairs Medical Center, Providence, RI 02908, USA;
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and poses significant burdens on patients, their families and the healthcare system. It is currently the fourth leading cause of death in the USA and is projected to rank fifth in burden of disease globally by 2020.1 Pulmonary rehabilitation (PR) for COPD is an effective therapeutic intervention that reduces breathlessness, increases exercise capacity and improves health-related quality of life.2 3 Emerging evidence also supports its effectiveness in reducing healthcare utilisation, decreasing frequency and severity of acute exacerbations and improving survival.4 5 6 7
Despite the robust evidence on the effectiveness of this intervention, the availability of PR remains dismal worldwide, with various estimates suggesting 1–14% of patients with COPD are actually referred for the service.8 9 10 This partly has to do with the fact that PR is most often delivered as an outpatient and hospital-based programme. If PR could be delivered effectively in the home setting, this could vastly increase the number of patients receiving this important therapy. Simply put, the right therapy for the right patient at the right time.
Few studies have looked at the efficacy of home-based rehabilitation, but the programmes vary widely, making comparisons difficult. One study from the Netherlands looked at a 12-week programme using community-based healthcare personnel and visits to local physiotherapists.11 While the study did demonstrate feasibility of the programme, high exercise compliance as assessed by patient diaries and some improvement of exercise tolerance, patients attended supervised exercise training …