As you may know I have a special interest in the physiotherapy management of Chronic Obstructive Pulmonary Disease (COPD). This long-term condition is generally caused by cigarette smoking but can also have genetic factors. COPD leads to impairment in lung function with patients suffering breathlessness on exertion, particularly when going upstairs or up slopes. They may have wheeze and cough and can also experience panic or anxiety associated with breathing. COPD is a very common disease and is one of the most frequent reasons for seeking medical attention. In the past decade or so there have been many advances in its treatment, not least the recognition of the role of the physiotherapist and the effectiveness of pulmonary rehabilitation. Pulmonary rehabilitation is an exercise and education programme -generally offered twice weekly for 8 weeks – designed for people with lung disease. There is plenty of evidence showing that pulmonary rehabilitation results in improved breathlessness, increased exercise tolerance and better quality of life. In the U.K you´ve got a good chance of being offered pulmonary rehabilitation as our guidelines specifically state that all patients with COPD troubled by breathlessness should be offered pulmonary rehabilitation.
But what about the situation here in Spain? A recent study published in the International Journal of COPD reports on a national audit of treatment of COPD in Spanish hospitals. Lopez-Campos and colleagues looked at 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals. They then compared the recorded notes with recommendations from the Spanish National Guideline for the treatment of COPD. The results show poor adherence to the guidelines in many therapeutic areas. Notably only 27% of patients had their inhaler techniquechecked; only 22% of smokers were offered a specific smoking cessation intervention; exercise performance (using a validated walking test) was reported in less than half the study population and only 41% of patients were even given advice regarding the importance of exercise. As to how many patients were offered pulmonary rehabilitation we simply don´t know!
On the other hand, the study showed that the Spanish hospitals recorded data on severity, diagnosis, frequency of chest infections and present medical treatments in most patients but many other aspects of recommended practice were not followed, or followed only in specialised centres.
Spain´s public health is to be commended for many outcomes, however there is a severe shortage of specialised nurses and physiotherapists, particularly those working in the community. It´s these gaps that need addressing in the management of COPD in Spain.
If you need physiotherapy help for your COPD please call or email
Dr Rachel Garrod
PhD MSc MCSP
Consultant Physiotherapist
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