Editorials

Rehabilitation after an exacerbation of chronic respiratory disease

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4370 (Published 08 July 2014) Cite this as: BMJ 2014;349:g4370
  1. William D-C Man, consultant chest physician1,
  2. Samantha S C Kon, MRC clinical research fellow1,
  3. Matthew Maddocks, lecturer in health services research2
  1. 1NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London
  2. 2King’s College London, Cicely Saunders Institute, London
  1. Correspondence to: W D-C Man, Department of Respiratory Medicine, Harefield Hospital, Middlesex UB9 6JH, UK research{at}williamman.co.uk

An early start in hospital followed by light touch supervision at home did not work for UK patients

Emergency hospital admissions for exacerbations of chronic respiratory disease—principally chronic obstructive pulmonary disease (COPD)—represent major life events for patients and place an enormous financial burden on healthcare systems. Readmission after hospital discharge is common and increasingly carries a financial implication for acute hospitals in both the United States and the United Kingdom.1

Pulmonary rehabilitation is an evidence based multidisciplinary intervention comprising exercise training, education, and behaviour change that is the cornerstone of non-drug management of adults with stable COPD. A Cochrane review summarising nine small, heterogeneous trials found clinically significant improvements in physical functioning, quality of life, and readmission rates after pulmonary rehabilitation delivered during or soon after a hospital admission.2 Consequently, recent guidelines recommend this approach.3 4

In a linked paper (doi:10.1136/bmj.g4315), Greening and colleagues report the results of a pragmatic two arm randomised controlled trial comparing an early rehabilitation strategy with usual care during and after admission to hospital for an exacerbation of chronic respiratory disease.5 This trial was adequately powered, with good patient uptake (only a quarter of …

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