Working together for lung health

Ema, who is a chartered physiotherapist, explains why pulmonary rehabilitation (PR) is so important, and how the Taskforce for Lung Health will help change lives. 

Breathing is something that many of us take for granted. But for people with a lung condition, it can be a daily, even hourly, concern with consequences for their quality of life. That’s why it’s so important that they get access to high-quality health care.

Sadly, access to high-quality health care is hard to get in too many parts of the country and people face delays in diagnosis, variable quality of treatment and patchy access to services. Services like pulmonary rehabilitation (PR), a programme of exercise and education for people with lung conditions, are significantly improve overall health and wellbeing. 

As someone who works in the field, the limited access to PR is incredibly frustrating.

PR services improve people's ability to exercise while reducing breathlessness and fatigue, to give people with chronic obstructive pulmonary disease (COPD) more control over their condition.

If we compare people who complete a PR course with those who don’t, results show they go to hospital less, and have over a third fewer flare ups.

The benefits are clear. Yet just 15% of eligible COPD patients are referred to a PR programme.

If someone does get a referral, the waiting times can be very long because services are overstretched – 37% of people wait for longer than 3 months.

As with nearly all areas of health care, the context is financial. Many services struggle to maintain funding when savings are sought.

This is short-term, short-sighted thinking because when patients do make it to a service, the results are excellent and cost-effective.

For example, the NHS Greater Glasgow and Clyde community respiratory team deliver PR to support patients going through a flare up of COPD instead of hospital admission.  This shifts the balance of care into the community.

The service enables self-management by improving patients’ knowledge of their condition, teaching them how to clear their chest and increasing their physical activity and independence.

The service has shown a 10% improvement in health-related quality of life for patients and it’s estimated to deliver savings each year of up to £1million.

Evaluation of the service has shown a 10% improvement in health-related quality of life for patients. And by offering self-referral and cutting hospital admissions, it’s estimated to deliver savings each year of up to £1million.

So we know it works – we've seen the evidence.

But how do we make sure no one misses out? How can we make this excellent service is available to everyone?

One of the main causes is the lack of a national, joined-up strategy for lung health. To change this, over 30 groups and individuals have banded together to form the Taskforce for Lung Health -  patients and representatives from the voluntary sector, professional associations, primary and secondary healthcare and industry, all working together.

We’re going to publish a 5-year plan for improving lung health in England, endorsed by the whole respiratory community. It will set out how to achieve the change that would allow everyone with lung disease to get the information, care and services they need.

The plan, which will be published in December, will be developed through thorough analysis of all available evidence.

Our work has already had an effect. We know now that PR is being considered as part of NHS England’s new long term plan. That’s because the evidence is so clear – investing in PR is the right thing for patients and the right thing for health budgets. We have worked together to highlight this and show how we can do things differently to get a better deal for people with lung disease.

The evidence is so clear – investing in PR is the right thing for patients and the right thing for health budgets.

If every eligible patient in England with COPD was referred for pulmonary rehabilitation there would be an annual decrease in flare ups of 151,000, a reduction of a third.

PR can make a massive difference. The evidence is overwhelming. It can change lives.


Ema Swingwood

Ema is the vice-chair of the Association of Chartered Physiotherapists in Respiratory Care and respiratory pathway lead/physiotherapist at University Hospitals Bristol NHS Foundation Trust.

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21 September 2018