Quality statement 5: Pulmonary rehabilitation after an acute exacerbation

Quality statement

People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge. [2011, updated 2016]

Rationale

Starting a pulmonary rehabilitation programme within 4 weeks of hospital discharge after an acute exacerbation reduces the short‑term risk of hospital readmission, and improves the quality of life and the short‑term exercise capacity of people with COPD.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that people with COPD admitted to hospital for an acute exacerbation start a pulmonary rehabilitation programme within 4 weeks of discharge.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme: pulmonary rehabilitation clinical audit and organisational audit.

Process

Proportion of people discharged from hospital after an acute exacerbation of COPD who start a pulmonary rehabilitation programme within 4 weeks of discharge.

Numerator – the number in the denominator who start a pulmonary rehabilitation programme within 4 weeks of discharge.

Denominator – the number of people discharged from hospital after an acute exacerbation of COPD.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme: pulmonary rehabilitation clinical audit.

Outcomes

a) Hospital admissions for acute exacerbations.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Quality of life.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

c) Exercise capacity.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme: pulmonary rehabilitation clinical audit.

What the quality statement means for different audiences

Service providers (secondary care and community services) ensure that systems are in place for people admitted to hospital for an acute exacerbation of COPD to start a pulmonary rehabilitation programme within 4 weeks of discharge.

Healthcare professionals ensure that people admitted to hospital for an acute exacerbation of COPD are referred for and receive a pulmonary rehabilitation programme within 4 weeks of discharge.

Commissioners (clinical commissioning groups) ensure that they commission services in which people who are admitted to hospital for an acute exacerbation of COPD are referred for and receive a pulmonary rehabilitation programme within 4 weeks of discharge.

People with COPD who have had a hospital stay because of a sudden flare up of their symptoms (called an acute exacerbation) start a pulmonary rehabilitation programme within 4 weeks of leaving hospital. This includes exercises, information about COPD, diet advice and support depending on the person's needs.

Source guidance

Definitions of terms used in this quality statement

Acute exacerbation

An exacerbation is a sustained worsening of a person's symptoms from their usual stable state and which is beyond usual day‑to‑day variations and acute in onset. Commonly reported symptoms are: worsening breathlessness, cough, increased sputum production and change in sputum colour.

[Adapted from NICE's guideline on chronic obstructive pulmonary disease]

Exercise capacity and physical activity levels are impaired during and after an exacerbation, contributing to skeletal muscle dysfunction, particularly of the lower limbs.

[Adapted from British Thoracic Society's guideline on pulmonary rehabilitation in adults]

Pulmonary rehabilitation programme

A multidisciplinary programme of care for people with chronic respiratory impairment that is individually tailored and designed to optimise each person's physical and social performance and autonomy.

[NICE's guideline on chronic obstructive pulmonary disease, recommendation 1.2.84 and British Thoracic Society's guideline for pulmonary rehabilitation in adults]

Pulmonary rehabilitation programmes should be held at times that suit people with COPD and in locations that are easy for people with COPD to get to, and have good access for people with disabilities. Programmes should be available within a reasonable time from referral.

[Adapted from NICE's guideline on chronic obstructive pulmonary disease, recommendation 1.2.83]

Programmes comprise individualised exercise programmes and education, and:

  • are at least 6 weeks in duration and include a minimum of twice‑weekly supervised sessions

  • include supervised, individually tailored and prescribed, progressive exercise training including both aerobic and resistance training

  • include a defined, structured education programme.

[British Thoracic Society's guideline on pulmonary rehabilitation in adults]

Equality and diversity considerations

Pulmonary rehabilitation is not suitable for people with unstable cardiac disease, locomotor or neurological difficulties precluding exercise such as severe arthritis or peripheral vascular disease, and people in a terminal phase of an illness or with significant cognitive or psychiatric impairment.

Some people with COPD may not be well enough to attend a pulmonary rehabilitation programme within 4 weeks of an acute exacerbation, may not have attended hospital after an acute exacerbation of COPD or may not have been admitted to hospital after their exacerbation of COPD.