1. Pulmonary Rehabilitation Primary Care Education Event 23/11/16
Martin Sterry
Physiotherapist – COPD &
Pulmonary Rehabilitation Teams

2. Aims of session What is it? Who is it for? What are the benefits?
Where is it?
How to refer?

3. What is it?
BTS 2013:
Interdisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy. Programmes comprise individualised exercise programmes and education
ATS/ERS 2013:
Comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviours.

4. What it’s not? “Breathing exercises” “Chest physio”
“Learn how to breathe”
“Somewhere nice to go and have a cup of tea and talk about breathing”
Key Message Needs to be:
Individualised and Adaptable
Physical exercise training
Education on self-management of chronic condition (including some breathing techniques)
Behaviour Change

5. What is it? No nationally agreed set-up (BTS Audit – 2015 / 2017)
Locally we run a service as:
Cohort programme
6 weeks, twice a week
Each session 2 hours – 1hr exercise / 1hr education
Exercise focused on endurance and strength
Education focused on knowledge of self-management of condition – medications / healthy diet / energy conservation

6. Who is it for?
1 a. People with COPD and self reported exercise limitation (MRC dyspnoea 3-5) are offered pulmonary rehabilitation.
2 Pulmonary rehabilitation programmes accept and enrol patients with functional limitation due to other chronic respiratory diseases (for example bronchiectasis, ILD and asthma) or COPD MRC dyspnoea 2 if referred.
3 a. People admitted to hospital with acute exacerbations of COPD (AECOPD) are referred for pulmonary rehabilitation at discharge.

7. Who is it not for?
Patients with unstable cardiac disease or locomotor difficulties that preclude exercise (eg, severe arthritis or severe peripheral vascular disease)
Careful consideration should be given to patients who have significant cognitive or psychiatric impairment that would lead to an inability to follow simple commands in a group setting.
In certain individual cases, facilitation of pulmonary rehabilitation may be aided by the support and attendance of a relative or carer.
In case of doubt over the appropriateness of a patient for pulmonary rehabilitation, clinicians are advised to contact their local provider.

8. What are the benefits? “Breathe better, feel good, do more”
Reduce dyspnoea
Increase exercise capacity
Improves quality of life
Improves symptoms of anxiety and depression
ATS, 2013
Post exacerbation: improves mortality (NNT 6), and reduced re-admissions (NNT4)
Puhan et al, 2011
“Breathe better, feel good, do more”
IMPRESS 2011

9. What are the benefits? LABA £8,000/QALY LAMA £7,000/QALY
Triple Therapy
£7,000-£187,000/QALY
LABA
£8,000/QALY
LAMA
£7,000/QALY
Pulmonary Rehabilitation
£2,000-8,000/QALY
Stop Smoking Support with pharmacotherapy £2,000/QALY
Flu vaccination £?1,000/QALY in “at risk” population
One QALY equates to one year in perfect health. If an individual's health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs, and in some circumstances it is possible to accrue negative QALYs to reflect health states deemed 'worse than dead'.

10. Where is it? Aim to have maximum 30mins travel from patients home
Venues flexible to demand / cost / availability
Mildenhall – St John’s Community Centre
BSE – Anselm Centre
Eye – Hertismere Hospital
Saxmundham – Riverside Centre
Kesgrave – Scout Hall
Stowmarket – Scout Hall
Newmarket – Memorial Hall
Haverhill – Leisure Centre
Great Waldingfield – Village Hall
Trimley St Martin – Parish Hall

11. How to refer? Post / Fax / Email referrals to CCC
eferral%20v1.doc
\Pulm Rehab Referral v1.doc
If referral suggested on clinic letter can just forward on
? Is referral form on S1 – can practice manager a copy
Include Diagnosis / PMH / Spiro / DH
Please don’t send referrals to COPD admission avoidance on this form
If unsure – get in touch or

12. Any questions?