title: Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure.
abstract: The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the 'most important' component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers.
authors.affiliation: NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, UK w.man@rbht.nhs.uk.
authors.forename: William D-C
authors.initials: WD
authors.lastname: Man
authors.affiliation: NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chowdhury
authors.affiliation: University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.affiliation: Centre of Exercise & Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom of Great Britain.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Evans
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
authors.affiliation: Centre of Exercise & Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom of Great Britain.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Singh
authors.affiliation: Department of Palliative Care and Cambridge University, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Booth
authors.affiliation: NHS West London Clinical Commissioning Group, London, UK.
authors.forename: Davey
authors.initials: D
authors.lastname: Thomason
authors.affiliation: NHS West London Clinical Commissioning Group, London, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Andrews
authors.affiliation: NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Cassie
authors.initials: C
authors.lastname: Lee
authors.affiliation: NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Hanna
authors.affiliation: University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Morgan
authors.affiliation: NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
mesh_terms: D032921:Consensus; D004417:Dyspnea / Q000209:etiology / Q000534:rehabilitation*; D006333:Heart Failure / Q000150:complications* / Q000534:rehabilitation; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000534:rehabilitation
keywords: Breathlessness; COPD; consensus; heart failure; rehabilitation