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Expanding pulmonary rehabilitation capacity. One size won't fit all
  1. Mike Morgan
  1. Correspondence to Professor Mike Morgan, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK; mike.morgan{at}uhl-tr.nhs.uk

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Pulmonary rehabilitation for people with chronic lung disease is a formal programme of care that includes supervised exercise and self-management training. The results of numerous clinical trials show that it can improve exercise capacity, dyspnoea and health status. These benefits have a larger effect size than can be obtained with any other medical therapy for COPD. The benefits last for approximately 12 months and can be regained with repeat programmes. Effective as it has been in a research setting, the challenge for the pulmonary rehabilitation community is to demonstrate that these positive findings can be reproduced in real life and that there is sufficient capacity in the health system to accommodate all those people that could benefit.

Earlier this year the Royal College of Physicians of London (RCP) produced the second of two publications from the largest audit of pulmonary rehabilitation in England and Wales that has ever been conducted.1 ,2 This audit included 7413 patients from 224 programmes in a wide variety of settings and described both the provision and the outcomes of rehabilitation. Even though the headline numbers appear impressive, the authors estimate that given 1.2 million people have COPD in the UK, only about 15% of patients with significant disability are ever referred for rehabilitation. The reasons for this are not clear but could relate to perceived lack of efficacy by referrers or lack of local capacity. The former is difficult to accept because the benefits of rehabilitation are clearly stated in all evidence-based clinical guidelines for COPD but referral may not yet be second nature to all primary or secondary care clinicians. Insufficient capacity, however, is certainly an important issue. In the RCP audit the median capacity of programmes was between 200 and 300 patients per year which is unlikely to satisfy the country's needs. …

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