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National COPD Audit Programme Pulmonary Rehabilitation report


A new report from the National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme reveals that pulmonary rehabilitation (PR) delivers significant health benefits but too many patients are missing out.

Key findings

  • The report finds there are many areas of good quality PR treatment for COPD patients, including widespread provision of walking (95%), cycle (70%) and aerobic and resistance exercise therapy (89%)
  • Patients that do complete PR, on average, show substantial improvements in quality of life and ability to exercise
  • But significant numbers of patients who attend a PR assessment do not complete the treatment (40%)
  • Almost one-third (26%) of patients are not given an ongoing individualised plan after discharge
  • Over a third of patients (37%) in England and Wales are waiting longer than the 3 months recommended in the British Thoracic Society (BTS) quality standards
  • Patients with a full range of self-reported exercise limitation were assessed and enrolled to PR. However, only 9% of patients who have the most severe disability were enrolled to PR

Recommendations include:

  • There is a need for greater awareness of the benefits of PR in primary and secondary care.
  • Commissioners and providers should ensure that all patients receive an offer to start PR treatment within the recommended 3 months following their referral
  • Referrers and patients should be provided with up-to-date and clear written information about the benefits of attending and completing PR

The report Pulmonary Rehabilitation: Steps to breathe better covers the second part of the COPD PR audit, reviewing the quality of care received by 7,413 patients across 210 PR services in the primary, secondary and community care sectors.  It can be accessed HERE

Action Points

Alex Woodward, respiratory physiotherapist and a member of the PCRS-UK Service Delivery Committee, recommends the following action points for:

GP practices:

  • Review the patients on your COPD register and make sure all those with a MRC Dyspnoea Scale grade 3 or above are referred to PR
  • Discuss the benefits of PR and the importance of exercise at every contact with a patient with COPD and make them fully aware of the benefits of completing PR.
  • Work with your PR provider to identify potential patients
  • Find out where and when your local PR service runs so you can fully inform patients what is involved

Service managers and respiratory leaders:

  • Contact your key local commissioner and arrange to meet with them to discuss PR and share the outcomes of the National PR Audit
  • Make commissioners aware of the improved outcomes PR brings about not only for patients but also for the local health economy
  • Work with commissioners, providers, referrers and patients/carers to ensure robust referral pathways for PR are in place for both patients with stable disease and those leaving hospital
  • Work with commissioners to investigate whether local data shows how many patients who have a score of MRC 3 and above there are locally and ensure the PR service is adequately resourced to meet this demand

PR providers:

  • Review and compare your local data and outcomes with national averages then create a local action plan to improve the quality of your service
  • Review your discharge processes to ensure all patients who complete PR and have a discharge assessment are provided with a written, individualised plan for continuing their exercise
  • Review your local processes, protocols and competencies for all the outcome measures you use to ensure they are performed to an accepted technical standard
  • Contact GP surgeries, other referrers and local Breathe Easy groups to educate them on the benefits of PR
  • Think of innovative ways to reduce the waiting time for PR and to improve the dropout rate from pulmonary rehab
  • Network locally with other PR providers to share best practice and ideas


The PCRS-UK does not guarantee, and accepts no legal liability for, the accuracy, reliability, currency or completeness of any archived material or linked website.  This is an archived resource/news item