Assessment and referral

 

Pulmonary rehabilitation referral

It is reported that a considerable number of patients are inappropriately referred to pulmonary rehabilitation services. It is further reported that many patients are unaware of the important benefits of pulmonary rehabilitation and how it can improve their quality of life.

Apart from smoking cessation, pulmonary rehabilitation is the most effective non-pharmaceutical intervention for people with COPD. 

All people with COPD who have functional impairment (MRC score 3 or more) could benefit from PR and should be referred. This represents about 50% of those diagnosed with the condition.

Specific referral criteria is needed before a patient can be successfully referred to a pulmonary rehabilitation programme.

Sample PR referral form

Downloads

Reluctance from patients to participate in PR

Any issues preventing patients from participating in PR should be addressed and hopefully overcome during referral discussions. An explanation of the potential benefits of PR should also be given.

Potential barriers to pulmonary rehabilitation:

  • transport difficulties
  • apprehension about exhaustion whilst travelling
  • disruption of usual living patterns
  • concern around an unfamiliar social situation
  • panic and alarm with breathlessness at exercise
  • fear of failure

Pulmonary rehabilitation is:

  • exercise training
  • education, including self-management
  • psychosocial support.

Expected benefits include:

  • improved exercise tolerance
  • improved quality of life
  • decreased symptoms
  • possible reduction in risk of admission / exacerbation.

Who should be referred for PR?

  1. Patients with chronic respiratory disease with an MRC of 3 or more. PR is not restricted to patients with COPD. Other diseases include Interstitial Lung Disease, Asthma, Emphysema, Bronchiectasis.
  2. Post COPD exacerbation patients.  There is strong evidence that patients in the recovery stages of an exacerbation benefit from pulmonary rehabilitation.

Exclusion Criteria

Patients with any uncontrolled medical condition, for example:

  • uncontrolled hypertension
  • unstable angina or other significant cardiac disease
  • unexplained or uncontrolled syncope or blackouts

Special consideration 

Special consideration or modification should be given to:

  • cognitive impairment  - utilisation of a carer or relative might overcome this issue
  • locomotor problems limiting participation in the course.

 

Published Date: 3 August 2011

Improvement