Pulmonary Rehabilitation in Newark and Sherwood

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1 Pulmonary Rehabilitation in Newark and Sherwood With exception of smoking cessation pulmonary rehabilitation is the single most effective intervention for any patient with COPD. A Cochrane review published in October 2012 found that treating just four patients with exacerbations prevents one hospital admission. One life is saved for every six patients completing a course. By comparison, 167 patients at risk of cardiovascular disease must take statins for more than four years to prevent one death. NICE Quality Standards for COPD (July 2011) state that people with COPD meeting appropriate criteria are offered an effective, timely and accessible multidisciplinary pulmonary rehabilitation programme. NICE CG101 COPD (June 2010) recommends that Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC grade 3 and above). Newark and Sherwood Clinical Commissioning Group provide a Pulmonary Rehabilitation service across the district. The programme includes education about COPD and living with a long-term condition, managing exacerbations and breathlessness. It offers advice on inhaler technique and device choice, the importance of diet and exercise- including chair-based exercise and Tai-Chi. Support and information is also provided around benefits, local patient support groups and the Expert Patients Programme. The courses are run by a multidisciplinary team. Newark Service Venue: Byron House, Newark Hospital Days/times: Tuesday & Thursday 3-5 pm Sessions: 2 sessions x6weeks, 12 sessions in total, 5 courses per year Type: Full Course and Booster (for those who have completed a full course at least 12 months prior and have deteriorated or been admitted to hospital admission. Transport: Provided if required (patient to arrange own if possible) Next start date: November, 2012 Group capacity: up to 15 Process of Referral: Complete attached referral form for either full course or booster and send or fax to Newark Health Clinic, Portland St. Newark NG24 4XG (Tel: Fax: )

2 Ollerton Service Venue: Dukeries Leisure Centre, Main St, Boughton. Ollerton Days/Times: Mon & Weds 2-4pm Next start date: November, 2012 Sessions: 6 week course, 5 courses per year. Group capacity: up to 15 Process of Referral: Complete attached referral form for either full course or booster and send or fax to Newark Health Clinic, Portland St. Newark NG24 4XG (Tel: Fax: ) Blidworth Service Venue: Blidworth Leisure Centre full details of programme to be confirmed, early Mansfield and Ashfield This service is no longer available to Newark and Sherwood patients. Please refer to local Newark and Sherwood service only. Date of Preparation: November 2012.

3 Pulmonary Rehabilitation - Community Referral Patient Name..NHS No:. DOB.. Address...Tel No: G.P...Address.Tel No:.. Name of Referrer Position Pulmonary Rehabilitation is supervised exercise and self management training. The therapy improves activity, reduces breathlessness, exacerbation frequency and hospital re-admission. Patients are required to attend twice weekly for 6 weeks (see over for contra-indications). Referral Criteria Please Tick Respiratory medication optimised (see over for NICE options). Last CXR: Date.. Last blood analysis: Date. ECG seen by GP and consented for patient to exercise.. Co-morbidities stable and treated optimally CXR, blood analysis (U&Es,FBC) and ECG must be within last 12 months and copies of reports must be attached. Thank You Respiratory diagnosis:- Spirometry: Date.. complete or attach copy FEV1 FVC FEV1/FVC Measured % Predicted Date performed

4 Smoking status (please circle):- Current / Ex / Never Smoking cessation advice given:- Y/N Date: Medication offered / undertaken:- Y/N Date: Number of chest infections in the past 12 months:- Number of respiratory admissions in the past 12 months:- MRC breathlessness grade (see over):- State current respiratory symptoms:- PLEASE ATTACH PRACTICE SUMMARY SHEET Signature.Date Contra-indications to pulmonary rehabilitation:- Lack of motivation/compliance Cancer Severe pulmonary hypertension Severe Heart Failure Recent MI Unstable angina Neuromuscular/locomotor disorders NICE Guidance for optimum treatment regimens Diagnosis of COPD confirmed with spirometry For symptoms of breathlessness & exercise limitation, FEV1 > 50% Use short-acting bronchodilator prn (beta 2 -agonist or anticholinergic) If still symptomatic try combined therapy with short-acting beta 2 - agonist and short-acting anticholinergic If still symptomatic use a long-acting bronchodilator (beta 2 -agonist or anticholinergic) Offer pulmonary rehabilitation to all patients who consider themselves functionally disabled (usually MRC grade 3, 4 or 5) Provide patient with self-management plan Still symptomatic consider referral to local COPD clinic For frequent exacerbations, FEV1<50% Optimise bronchodilator therapy with long-acting bronchodilator (beta 2 -agonist OR anticholinergic)

5 Add inhaled corticosteroids for 2 or more exacerbations in a 12 month period (these will be combined with long-acting bronchodilators) MRC Breathlessness Grades 1 Not troubled by breathlessness except on strenuous exercise 2 Short of breath when hurrying or walking up a slight hill 3 Walks slower than people of the same age on level ground because of breathlessness, or has to stop for breath when walking at own pace 4 Stops for breath after walking about 100 m or after a few minutes on the level ground 5 Too breathless to leave the house or breathless when dressing or undressing Where possible patients will be offered a choice of venue nearest to their home. Send completed form to your nearest PR site: Newark Health Centre, Portland Street Newark NG24 4XG (Tel: ) Mark for the attention of the Pulmonary Rehabilitation Service (Form 1a:rev 23/06/2011)

6 Booster Pulmonary Rehabilitation Referral Patient Name..Hosp No:. DOB.. Address...Tel No: Consultant Hospital...G.P. Name of Referrer Position.... Pulmonary Rehabilitation is a programme of supervised exercise training to improve fitness and muscle strength. The training improves activity, reduces breathlessness, exacerbation frequency and hospital re-admission. Patients are required to attend exercise sessions twice weekly for 3 weeks (see over for contra-indications). Referral Criteria Medication should be optimised (see over for NICE options). All co-morbidities should be stable. Patients will not be accepted without spirometry and smoking cessation advice. Must have attended Pulmonary Rehabilitation more than 12 months ago. Consider GP exercise referral scheme if appropriate Suffered prolonged deterioration and delayed recovery post exacerbation Respiratory diagnosis:- Spirometry Y/N FEV1 FVC FEV1/FVC Measured % Predicted Date performed Smoking status (please circle):- Current / Ex / Never Smoking cessation advice given:- Y/N Date: Medication offered / undertaken:- Y/N Date: Number of chest infections in the past 12 months:- Number of respiratory admissions in the past 12 months:- MRC breathlessness grade (see over):- Date of last rehab attendance. State any new medical problems/changes in clinical status since previous Pulmonary Rehabilitation:- List inhaled therapy / oxygen:-

7 List co-morbidities, give brief details and current treatment:- Signature.Date Contra-indications to pulmonary rehabilitation:- Lack of motivation/compliance Cancer Severe pulmonary hypertension Severe Heart Failure Recent MI Unstable angina Neuromuscular/locomotor disorders NICE Guidance for optimum treatment regimens Diagnosis of COPD confirmed with spirometry For symptoms of breathlessness & exercise limitation Use short-acting bronchodilator prn (beta 2 -agonist or anticholinergic) If still symptomatic try combined therapy with short-acting beta 2 -agonist and short-acting anticholinergic If still symptomatic use a long-acting bronchodilator (beta 2 -agonist or anticholinergic) In moderate or severe COPD: If still symptomatic consider a trial of combined long-acting beta 2 -agonist and inhaled corticosteroid. Discontinue if no benefit after 4 weeks If still symptomatic consider adding theophylline Offer pulmonary rehabilitation to all patients who consider themselves functionally disabled (usually MRC grade 3, 4 or 5) Consider referral for surgery: bullectomy, LVRS, transplantation For frequent exacerbations Optimise bronchodilator therapy with one or more long-acting bronchodilator (beta 2 -agonist or anticholinergic) Add inhaled corticosteroids if FEV1<50% and 2 or more exacerbations in a 12 month period (NB These will usually be used with long-acting bronchodilators) MRC Breathlessness Grades 1. Not troubled by breathlessness except on strenuous exercise 2. Short of breath when hurrying or walking up a slight hill 3. Walks slower than people of the same age on level ground because of breathlessness, or has to stop for breath when walking at own pace 4. Stops for breath after walking about 100 m or after a few minutes on the level ground 5. Too breathless to leave the house or breathless when dressing or undressing Where possible patients will be offered achoice of venue nearest their home_ Send completed form to your nearest PR site for processing:

8 Newark Health Centre, Newark, NG24 4XG (Tel: ) Mark for the attention of the Pulmonary Rehabilitation Service (Form 2: 01/2012)

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