Document type: Clinical pathways
Place: East and North Hertfordshire
Output type: Clinical Pathways
Pathway: Pulmonary Rehabilitation

Pulmonary Rehabilitation

Pulmonary Rehabilitation Group sessions are for patients with a respiratory diagnosis who suffer with shortness of breath on exertion and are deconditioned.

Pulmonary Rehabilitation Individual sessions are for patients who have respiratory problems such as repeated chest infections or are in need of a programme of breathing re-education.

Group Pulmonary Rehabilitation Criteria

Patient should have a confirmed respiratory diagnosis
Functional limitation due to breathlessness (MRC2 or above)
Patient willing and able to travel to venue for pulmonary rehabilitation.
No exclusion criteria present such as:
- Signs of symptomatic heart failure
- Uncontrolled Hypertension: (Resting systolic > 200 mm Hg - diastolic >120 mm Hg)
- Severe or uncontrolled epilepsy
- Myocardial infarction within the last 6 weeks
- Tachycardia - >100bpm (relative CI) above 120bpm (absolute CI) at rest
- Unstable angina
- Patients with an AAA > 5.5cm will be accepted for gentle aerobic exercise but will not be prescribed resistance training

Optimised inhaled therapy
Consider mucolytics
If SpO2 ≤92% ensure on maximal therapy & consider referral to home oxygen service prior to referral
Able to walk safely
Able to attend and commit to a group. Note that if unable to commit or attend group sessions consider individual rehabilitation referral.

Individual Pulmonary Rehabilitation Criteria

Patient is symptomatic and presents with dysfunctional breathing pattern +/-diagnosis of asthma and requires an individualised programme of breathing re-education
Patient presents with repeated exacerbations/chest infections and requires individualised programme of chest clearance techniques
Patient is breathless but is unable to attend group sessions.

For the HOOF forms please go directly to the BOC portal - they are the people who supply the oxygen. Their number is 088456 094345

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