November 25, 2016

Pulmonary Rehabilitation: The Best Intervention for COPD

Pulmonary rehabilitation is one of the most effective interventions for people living with chronic lung disease, but less than 5% of patients access the program.

That’s why this World COPD Day (16 November), Lung Foundation Australia is urging health professionals to refer people diagnosed with COPD to pulmonary rehabilitation.

COPD or Chronic Obstructive Pulmonary Disease, affects approximately one in seven Australians aged 40 and over1, is the second leading cause of hospitalisation2 and is the fifth leading cause of death3.

Royal Prince Alfred Hospital Respiratory Physiotherapist, Dr Lissa Spencer said, “Optimal management of a patient’s condition, including pulmonary rehabilitation and patient self-management, improves outcomes.  The evidence shows that pulmonary rehabilitation reduces symptoms, improves exercise capacity and strength, reduces anxiety and depression and, reduces hospital admissions4.”

“The Australian guidelines recommend that after GPs diagnose and assess a patient’s baseline functional status, non-pharmacological strategies should be provided to all patients with COPD. These include smoking cessation strategies, regular physical activity and pulmonary rehabilitation.

“The guidelines recommend pulmonary rehabilitation for all patients with exertional dyspnoea as well as re-assessing and considering re-referral to pulmonary rehabilitation for patients who have stopped being active5,” Dr Spencer said.

Heather Allan, CEO of Lung Foundation Australia, said the Foundation has applied to the Medical Services Advisory Committee (MSAC) for pulmonary rehabilitation programs and follow-up pulmonary maintenance exercise programs to be subsidised on the Medicare Benefit Scheme (MBS). The success of the application will be known in November later this year.

“Many patients are referred to pulmonary rehabilitation by respiratory physicians in hospitals despite general practitioners (GPs) being the most likely point of contact for people with chronic lung disease. We hope the MBS item number will enable more GPs to refer patients to pulmonary rehabilitation and the long term benefit of it will be evident across the spectrum of the health system,” Mrs Allan said.

About pulmonary rehabilitation

Pulmonary rehabilitation is an eight week program consisting of exercise and education sessions.   It includes a pre-assessment and a post-assessment. Based on this initial assessment an individually tailored program is prescribed for the participant.

Final post-assessment of the participant includes retesting functional exercise capacity, assessment of health status and psychosocial assessment to measure patient outcomes. A letter is written to the referring doctor.

Lung Foundation Australia has identified 274 pulmonary rehabilitation programs across Australia of which 196 are public and 75 are private.

References

  1. Toelle B, Xuan W, Bird T, Abramson M, Atkinson D, Burton D, James A, Jenkins C, Johns D, Maguire G, Musk A, Walters E, Wood-Baker R, Hunter M, Graham B, Southwell P, Vollmer W, Buist A, Marks G. Respiratory symptoms and illness in older Australians: The Burden of Obstructive Lung Disease (BOLD) study. Med J Aust 2013;198:144-148
  1. Page A, Ambrose S, Glover J et al. Atlas of Avoidable Hospitalisations in Australia: ambulatory care-sensitive conditions. Adelaide PHIDU. University of Adelaide.  2007
  1. Australian Institute of Health and Welfare 2016. AIHW National Mortality Database.
  1. O’Donnell DE, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2007 update. Canadian Respiratory Journal 2007;14(Suppl B):5B-32B
  1. Abramson M, Crockett A, Dabscheck E, Frith P et al. Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease. 2014 http://www.copdx.org.au/