Respiratory therapists know pulmonary rehabilitation can help COPD patients regain lost functioning, and many believe these patients can be effectively treated at home when the condition flares up as well.
In a new set of guidelines aimed at helping clinicians care for COPD patients with an acute exacerbation, the American Thoracic Society and European Respiratory Society agree.
While the guidelines do not recommend pulmonary rehab during the hospital stay itself, they do recommend beginning such a program within three weeks of discharge. They also recommend a home-based management approach for patients who present to the hospital or emergency department with a COPD exacerbation.
“Pulmonary rehabilitation implemented within three weeks after discharge following a COPD exacerbation reduces hospital admissions and improves quality of life,” write the authors. Additional studies to identify interventions that provide the biggest benefits to patients and test strategies to overcome barriers to and facilitators of the integration of pulmonary rehab into the patient’s plan of care are needed.
When it comes to home management of patients, the authors note that the “home-based management program model in patients with a COPD exacerbation reduces hospital admissions, making it a safe and effective way of discharging patients with additional home-based support in appropriately selected patients.”
They call for more study to define the patient selection criteria and key elements of such programs, particularly who will staff them – for example, nurses or interprofessional teams that include a physician, respiratory therapist, or social worker.
Other recommendations in the guidelines call for a course of oral corticosteroids of 14 days or less in ambulatory patients, along with antibiotics, with selection of antibiotics to be based on local sensitivity patterns.
The administration of oral corticosteroids rather than intravenous corticosteroids is also recommended, if gastrointestinal access and function are intact. In patients with acute or acute-on-chronic hypercapnic respiratory failure, they believe noninvasive ventilation may be warranted in patients who are hospitalized as well.
Whether you already have a pulmonary rehabilitation program in your facility or are thinking about starting one, the AARC’s Pulmonary Rehabilitation Program Toolkit can help ensure you are correctly setting the charge for G0424, the Medicare code for the pulmonary rehabilitation benefit.