COMMUNITY-BASED PULMONARY REHABILITATION: MEETING DEMAND IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

People with chronic obstructive pulmonary disease (COPD), a progressive respiratory disease characterised by fixed airflow obstruction, report symptoms of breathlessness, weakness, fatigue, and mood disturbances of anxiety and/or depression. Pulmonary rehabilitation, an interdisciplinary programme of physical training, education, and cognitive behavioural therapy addresses these symptoms. Randomised controlled trials have shown that pulmonary rehabilitation in COPD results in improved exercise tolerance and reduced breathlessness, reduction in bed-day usage, and fewer exacerbations. To date, the majority of rehabilitation programmes have been provided as hospital out-patient services. However, there is increasing recognition that rehabilitation availability and access is limited at present and community programmes are proposed as a means of addressing these issues. Community rehabilitation programmes provided early after an exacerbation or during the stable phase have shown beneficial effects in COPD with respect to health outcomes and reduced health utility measures. This review advocates increased community rehabilitation and highlights the implementation of new services with a view to the development of holistic long-term strategies aimed at enhancing exercise behaviour in patients with COPD.