Updated BTS Clinical Statement on Pulmonary Rehabilitation

The committee chaired by Professor Will Man and Professor Sally Singh, and included a wide range of health care professionals involved in the delivery of pulmonary rehabilitation services but also had experience of either conducting research in the field or skilled in reviewing the literature. Importantly we also had service users contributing at every stage of the process. The group agreed that the topics covered in the 2013 statement remained valid and therefore were not revisited but guidance remains. The topics selected to be reviewed largely reflected the growth of evidence in the field of rehabilitation, but also tackled some areas where there is less certainty about the strength of the evidence particularly where the research may not be wholly relevant to how services are delivered in the UK. The COVID-19 pandemic obviously was a huge disrupter to the delivery of rehabilitation and challenged services to deliver innovative packages of care to support individuals with chronic lung disease, by definition these would not fulfil the definition of pulmonary rehabilitation but have changed the appetite for alternative models of delivery. Telehealth is in its infancy and the term is widely used to cover a range of different intervention. To date the impact of an alternative form of delivery does not seem, on the whole, to be as effective as supervised rehabilitation delivered across England and Wales (National Respiratory Audit Data), therefore much more evidence is required to fully understand the value of these novel intervention and who might be best suited to them.

The scope of rehabilitation has been reviewed and the statement identifies an increased body of knowledge to include individuals with other respiratory diseases (including interstitial lung disease, asthma, and bronchiectasis) , as well as participants being considered for thoracic surgery, or volume reduction procedures, pulmonary hypertension,  post COVID-19 condition and chronic heart failure. There is also a section that identifies how services might maximise their referral rates into the service with advice for both referrers and the service.

This updated statement will form the foundation of a standards review for the Pulmonary Rehabilitation Services Accreditation Scheme, which is intertwined with the National Respiratory Audit Programme, both hosted by the Royal College of Physicians.