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British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE
  1. Charlotte E Bolton1,
  2. Elaine F Bevan-Smith2,
  3. John D Blakey3,
  4. Patrick Crowe4,
  5. Sarah L Elkin5,
  6. Rachel Garrod6,
  7. Neil J Greening7,
  8. Karen Heslop8,
  9. James H Hull9,
  10. William D-C Man10,
  11. Michael D Morgan7,
  12. David Proud11,
  13. C Michael Roberts12,
  14. Louise Sewell7,
  15. Sally J Singh13,
  16. Paul P Walker3,
  17. Sandy Walmsley14,
  18. British Thoracic Society Pulmonary Rehabilitation Guideline Development Group, on behalf of the British Thoracic Society Standards of Care Committee
  1. 1Nottingham Respiratory Research Unit, University of Nottingham, City Hospital campus, Nottingham, UK
  2. 2Department of Pulmonary Rehabilitation, Worcestershire Royal Hospital, Worcester, UK
  3. 3Respiratory Medicine, University Hospital Aintree, Liverpool, UK
  4. 4Patient representative, Mansfield, UK
  5. 5Department of Respiratory Infection and Medicine, Imperial College Healthcare NHS Trust, London, UK
  6. 6Pulmonary Rehabilitation Department, Kings College NHS Foundation Trust, London, UK
  7. 7Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
  8. 8Respiratory Medicine, Royal Victoria Infirmary, Newcastle, UK
  9. 9Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  10. 10Department of Respiratory Medicine, NIHR Biomedical Research Unit for Advanced Lung Disease, Harefield, UK
  11. 11Respiratory Medicine, University Hospital Llandough, Penarth, S Wales, UK
  12. 12Respiratory Medicine, Whipps Cross Hospital, London, UK
  13. 13Department of Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
  14. 14Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to British Thoracic Society, 17, Doughty Street, London WC1N 2PL, UK; bts{at} and Dr Charlotte E Bolton, Nottingham Respiratory Research Unit, University of Nottingham, Clinical Sciences Building, City Hospital campus, Hucknall road, Nottingham, NG5 1PB, UK; charlotte.bolton{at}

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Summary of recommendations

The role of pulmonary rehabilitation

  • Pulmonary rehabilitation should be offered to patients with chronic obstructive pulmonary disease (COPD) with a view to improving exercise capacity by a clinically important amount. (Grade A)

  • Pulmonary rehabilitation should be offered to patients with COPD with a view to improving dyspnoea and health status by a clinically important amount. (Grade A)

  • Different components within a pulmonary rehabilitation programme, such as resistance training, can influence quadriceps strength and this is addressed in the section ‘Nature of training of these guidelines’. (√)

  • Pulmonary rehabilitation should be offered to patients with COPD with a view to improving psychological wellbeing. (Grade A)

  • As a minimum, efficacy of pulmonary rehabilitation programmes needs to be regularly assessed by demonstrating clinically important improvements in exercise capacity, dyspnoea and health status. (Grade B)

  • As part of regular assessment, patient satisfaction and feedback should be sought. (√)

Referral and assessment of patients for pulmonary rehabilitation

  • The point of referral to pulmonary rehabilitation should be used as an opportunity to explore the patient's understanding of pulmonary rehabilitation, address concerns and to educate patients about the benefits of a pulmonary rehabilitation programme. (√)

  • Healthcare professionals making referrals to pulmonary rehabilitation should have basic knowledge about what a programme entails and effectiveness. A pulmonary rehabilitation programme should be presented by the referrer as a fundamental treatment for COPD rather than an optional extra. (√)

  • Initial assessment for pulmonary rehabilitation provides an opportunity to assess and refer for treatment of comorbidities prior to commencing. (√)

  • The setting of pulmonary rehabilitation, skill mix of the team and other comorbidities should always be considered in the risk assessment of patients entering a rehabilitation programme. (√)

Specific situations at assessment

  • Patients with COPD should be referred for pulmonary rehabilitation regardless of their smoking status. (Grade D)

  • Patients referred to pulmonary rehabilitation should have their smoking status assessed and referral to smoking cessation services offered to smokers simultaneously. …

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  • Funding The meeting room, travel expenses, literature search and associated administration costs were funded by the BTS.