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
score 3 or more) could benefit from PR and should be referred.
This represents about 50% of those diagnosed with the
Specific referral criteria is needed before
a patient can be successfully referred to a pulmonary
Sample PR referral form
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
- 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?
- 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.
- Post COPD exacerbation patients. There is strong evidence
that patients in the recovery stages of an exacerbation benefit
from pulmonary rehabilitation.
Patients with any uncontrolled medical condition, for
- uncontrolled hypertension
- unstable angina or other significant cardiac disease
- unexplained or uncontrolled syncope or blackouts
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