Pulmonary rehabilitation underused in COPD

Data from an Australian hospital show that chronic obstructive pulmonary disease (COPD) patients admitted for exacerbations are rarely referred for pulmonary rehabilitation (PR), despite it being strongly recommended by national treatment guidelines.

“Rehabilitation in people with COPD has been shown to significantly reduce dyspnoea and fatigue, and improve exercise capacity, emotional function and people’s sense of control over their disease, and reduce health-care utilization,” comment authors Kylie Johnston (University of South Australia, Adelaide) and colleagues.

But they say that their findings support those of a handful of studies to date suggesting that PR is substantially underused.

The team interviewed 88 patients who were admitted to hospital with a primary diagnosis of COPD between March and November 2011.

They found that only 50 (57%) patients had ever been referred for PR, and only 16 (18%) had completed at least half of the prescribed sessions.

Additionally, during the current hospital admission, only 14 (16%) patients reported that they had discussed rehabilitation with the medical team and been referred for PR. Johnston et al comment that this is identical to the rate reported at an Australian hospital 10 years previously, suggesting that “[s]urprisingly little seems to have changed with regard to referral to rehabilitation in the last decade, in spite of increased availability of programs and more widespread knowledge of effectiveness of PR.”

The researchers were unable to assess why physicians did not refer patients for PR, but it did not appear to be a decision made on the basis of clinical characteristics as none were associated with the odds for referral. The only significant factor associated with PR referral was being seen by the consultant nurse coordinator of the COPD program; these patients were 18.7-fold more likely to be referred for PR than those who did not see the nurse coordinator (40.0 vs 3.4%).

The team also notes that of those patients who had previously begun a PR program, 73% completed at least half of the sessions, which they say indicates that the decision to embark upon PR may be the biggest hurdle to attendance.

“Further qualitative data to examine structural and behavioural barriers to referral and implementation of rehabilitation for people with COPD is indicated,” the authors conclude, writing in Respirology.

“Given the lack of improvement in this area in Australia and internationally during the last decade, translational research that goes beyond describing the problem, to implementing sustainable interventions based on sound theoretical models is urgently required.”

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