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COPD Supplement
A practical guide for Primary Care Nurses

The Burden of COPD COPD Guide PDF
Spirometry
Smoking Cessation
Pulmonary Rehabilitation
Appendix One - Resources and contacts
Update on Managing Smoking Cessation - BMJ review July 2007

Pulmonary Rehabilitation9

Pulmonary rehabilitation is one of the most effective interventions in COPD, and has been shown to reduce symptoms and improve functioning by:

  • Improving cardiovascular fitness, muscle function and exercise endurance.
  • Enhancing self-confidence, coping strategies and adherence to treatment.
  • Improving mood and social functioning.

Pulmonary rehabilitation should be offered to all patients with moderate or severe COPD and will probably benefit others. It is effective in both community and hospital based settings but is probably most cost-effective in hospital outpatients.

Programme content

Outpatient programmes should contain a minimum of 6 weeks of physical exercise, disease education, psychological, and social intervention.

Physical exercise

Training frequency should involve three sessions (20-30 minutes) per week of which at least two should be supervised. The exercise prescription should be individually assessed.

Physical aerobic training, particularly of the lower extremities (preferably brisk walking or cycling) is essential. Upper limb and strength building exercise can also be included.

Training should usually be of mid-intensity. However, benefit can be obtained from lower intensity training where necessary and increased benefits can be obtained from higher intensity training when this can be achieved. Individual training intensity should be recorded and can be increased through the programme where tolerated.

Supplementary oxygen during training may need to be provided.

Disease education

Comprehensive disease education for patients and families is an important part of overall management that can be conducted within the rehabilitation programme. Individual advice on physiotherapy, nutrition, occupational therapy, and smoking cessation helps improves adherence to these programmes.

Psychological and social interventions

During pulmonary rehabilitation advice should be provided for emotional issues related to COPD. These include end of life planning and the constraints that COPD may impose on sexual activity.

Outcome measures

Outcome measures should be embedded in the programme as part of the process and should reflect the goals of rehabilitation. These goals cannot be expressed solely as lung function measurement, and must include measures of relevant impairment, disability, handicap, and domestic activity. Outcome measures need only be simple, but centres with expertise can use advanced technology.


9 BTS Standards of Care subcommittee. Pulmonary Rehabilitation. Thorax 2001;56:827-34.
http://thorax.bmjjournals.com/cgi/reprint/56/11/827 (Accessed March 2005).


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