The therapeutic efficacy of pulmonary rehabilitation is now well established and supported by a substantial body of clinical trial evidence.1 ,2 The place of pulmonary rehabilitation in the management of chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases has been enshrined in national and international guidelines including those recently produced by the British Thoracic Society.3 In recent years, attention has shifted from questions regarding the effectiveness of the intervention for those who successfully attend and complete a programme, to meeting challenges for the delivery of pulmonary rehabilitation to the wider population with disabling lung disease. A key driver of this focus is the perception in many quarters that uptake and adherence to rehabilitation is poor, and that a significant minority of patients do not fully respond, or quickly decline, once the programme is completed. As a result, there is considerable interest in developing and testing alternative delivery models of pulmonary rehabilitation and other behavioural interventions that aim to improve general health, knowledge of the disease and promote self-care.

Casey et al4 presents data from the PRINCE study which reports on the delivery of a structured education pulmonary rehabilitation programme (SEPRP) in a primary care setting. This is not the first study of pulmonary rehabilitation in the community,5 ,6 but the PRINCE study has taken an alternative approach. The authors describe a tightly controlled cluster ramdomised controlled trial (RCT) of a rehabilitation intervention versus best usual care in a group of participants with moderate to severe COPD. The authors should be congratulated on conducting such a rigorous randomised controlled trial in a large study population. Participants underwent an 8-week programme, comprising weekly sessions of exercise and education, followed by a telephone call at 4 weeks postdischarge, and a 1 h …