Quality standard

Quality statement 4: Pulmonary rehabilitation for stable COPD and exercise limitation

Quality statement 4: Pulmonary rehabilitation for stable COPD and exercise limitation

Quality statement

People with stable chronic obstructive pulmonary disease (COPD) and a score of 3 or above on the Medical Research Council (MRC) dyspnoea scale are referred to a pulmonary rehabilitation programme. [2011, updated 2023]

Rationale

People with stable COPD may experience exercise limitation because of breathlessness. Pulmonary rehabilitation programmes improve a person's exercise capacity, quality of life, symptoms and levels of anxiety and depression.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of people with stable COPD and a score of 3 or above on the MRC dyspnoea scale who are referred to a pulmonary rehabilitation programme.

Numerator – the number in the denominator who are referred to a pulmonary rehabilitation programme.

Denominator – the number of people with stable COPD and a score of 3 or above on the MRC dyspnoea scale.

Data source: NHS England's Quality and Outcomes Framework includes data on people with COPD, a score of 3 or above on the MRC dyspnoea scale and a recorded offer of referral to a pulmonary rehabilitation programme (excluding those who have previously attended).

b) Proportion of attendances of people with stable COPD and a score of 3 or above on the MRC dyspnoea scale that result in the person completing a pulmonary rehabilitation programme.

Numerator – the number in the denominator that result in the person completing a pulmonary rehabilitation programme.

Denominator – the proportion of attendances of people with stable COPD and a score of 3 or above on the MRC dyspnoea scale at pulmonary rehabilitation programmes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (secondary care and community services) ensure that systems are in place for people with stable COPD and a score of 3 or above on the MRC dyspnoea scale to be referred to a pulmonary rehabilitation programme.

Healthcare professionals refer people with stable COPD and a score of 3 or above on the MRC dyspnoea scale to a pulmonary rehabilitation programme.

Commissioners ensure that they commission services in which people with stable COPD and a score of 3 or above on the MRC dyspnoea scale are referred to a pulmonary rehabilitation programme.

People with COPD that is stable who have difficulty walking, have to walk slowly, and stop often or soon become breathless are referred to a pulmonary rehabilitation programme. This includes exercises, information about COPD, diet advice and support depending on the person's needs.

Source guidance

Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115 (2018, updated 2019), recommendations 1.2.81 and 1.2.82

Definitions of terms used in this quality statement

Medical Research Council (MRC) dyspnoea scale: grade 3 and above

A breathlessness of grade 3 is defined as 'walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace'. Grade 4 is defined as 'stops for breath after walking about 100 metres or after a few minutes on level ground'. Grade 5 is defined as 'too breathless to leave the house, or breathless when dressing or undressing'. [NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendation 1.1.3]

Pulmonary rehabilitation programme

A multidisciplinary programme of care for people with chronic respiratory impairment that is individually tailored and designed to optimise each person's physical and social performance and autonomy.

Pulmonary rehabilitation programmes should be held at times that suit people with COPD and in locations that are easy for people with COPD to get to, and have good access for people with disabilities. Programmes should be available within a reasonable time from referral.

Programmes comprise individualised exercise programmes and education, and:

  • are at least 6 weeks in duration and include a minimum of twice‑weekly supervised sessions

  • include supervised, individually tailored and prescribed, progressive exercise training including both aerobic and resistance training

  • include a defined, structured education programme.

[Adapted from NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendation 1.2.83 and 1.2.84, and the British Thoracic Society's quality standard on pulmonary rehabilitation in adults]

Equality and diversity considerations

Pulmonary rehabilitation is not suitable for people with unstable cardiac disease, locomotor or neurological difficulties precluding exercise such as severe arthritis or peripheral vascular disease, and people in a terminal phase of an illness or with significant cognitive or psychiatric impairment.