Bronchiectasis-specific pulmonary rehabilitation

Kayleigh Owen – Specialist Respiratory Physiotherapist


Swansea Bay University Health Board

Background

Pulmonary Rehabilitation (PR) is a multidisciplinary programme recognised as a key management strategy for those with chronic respiratory impairment.


People living with bronchiectasis are offered generic PR programmes which focus heavily on Chronic Obstructive Pulmonary Disease (COPD). Unlike COPD, Bronchiectasis is in many cases idiopathic or linked to acute childhood respiratory illnesses like whooping cough meaning education on topics such as smoking cessation and inhaler technique are often irrelevant.


Other than generic PR programmes, Bronchiectasis patients attend Respiratory Consultant and Respiratory Physiotherapy clinics, spending on average just 2 hours per year with healthcare professionals but would benefit from more input.

Project Aims

  • Provide group exercise and tailored self-management education for people living with Bronchiectasis in a 6-week course.

  • Provide a safe environment to encourage regular exercise and understand the benefits of an active lifestyle for those with Bronchiectasis

  • Provide understanding of the symptoms people are experiencing and strategies to control and manage these

  • Empower patients to manage their condition to prevent deterioration and maintain a higher quality of life

  • Provide a supportive peer environment to share experiences and a support group to learn within

Challenges

The global COVID-19 pandemic impacted the programme with all face-to-face patient contact being cancelled in mid-March. We were in the 5th week of the second programme at that point.


Since then, a PR programme with a COPD cohort has been piloted with social distancing and increased infection control measures with success. However, venue suitability and cohort sizes have been impacted.


Patient referrals for this service came from well-engaged Respiratory Consultant-led clinics. We have seen the number of referrals reduce in line with the reduction of face-to-face clinics as a result of the pandemic.

Key Outcomes

  • 62% of patients offered pre-assessment appointments accepted. Reasons for declining included issues with transport, distance to travel and work commitments.

  • 88% of patients assessed attended the course, one patient became unwell before the course started.

  • 71% of those that started the course completed >75% of the sessions. Only one patient that started the course did not complete and attend post-assessment.

  • The two patients that fell within the ‘severe’ category of the Bronchiectasis Severity Index course did not complete the PR course due to illness.

  • 66% of attendees improved their exercise tolerance as measured by the Incremental Shuttle Walk Test (outcome measure used to assess exercise capacity in chronic respiratory impairment)



  • 83% of attendees reported improvement in their self-reported health status measured using the Bronchiectasis Health Questionnaire. There was further improvement in this score for 50% of attendees at a 9-month follow-up.

  • Only one attendee (patient 6) had required a hospital admission since completing the course. This person was discharged from hospital the same week as the 9-month review which may have impacted on the follow-up results.

“The best part is you are with people who have the same problem, making you feel at ease”
“I don’t feel ill anymore”
“Given me the knowledge to control the condition, a more positive mind set and helped me feel better and in control”
“All the information received has been so helpful”
“The programme has helped me realise that I could manage my condition with breathing techniques, how to cough, reduce my anxiety, exercise and good diet”

Next Steps

Further feedback on education topics can guide what is most useful for people living with Bronchiectasis.


We will explore the potential for a longer programme; for example eight weeks rather than the six-week model used by the majority of generic PR courses. This could provide an opportunity to see greater improvements in exercise tolerance and emphasise some of the learning topics.


We aim to rollout across the health board to provide the service in more local communities.


The British Thoracic Society Guideline for Bronchiectasis in Adults (2019) noted a research recommendation to explore the role of education, self management plans and who delivers pulmonary rehabilitation. Our project can play a key role in this research.

My Exemplar Experience

Being a Bevan Exemplar has taught me the importance of networking in pursuing your ideas and making them a reality.

With thanks

Huge thanks to Hayley Thomas for all her work in collating the data for this. Thank you to the Swansea Bay University Health Board Pulmonary Rehabilitation for their support and enthusiasm for this project. Special thanks to Tracey Eldred for creating the digital story and Jo for recording it.

Contributor

Kayleigh Owen – Specialist Respiratory Physiotherapist

Kayleigh.owen@wales.nhs.uk

@respphysioko

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