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Making surgery safer for people with copd

COPD is Chronic Obstructive Pulmonary Disease, a condition in which lung damage leads to shortness of breath and increased risk of chest infections. In the UK, COPD affects nearly 4 million people and is Britain’s 5th biggest killer (30,000 deaths/year).

Following surgery, people with COPD have 35% more complications and a 29% greater chance of dying, this is particularly due to chest infections, wound infections and heart attack. Therefore there is an urgent need to make surgery safer.

Pulmonary rehabilitation is a programme of activity and education for people with COPD. It helps make people fitter, more active and less breathless. Pulmonary rehabilitation following flare-ups reduces re- hospitalisation by over 50%. If pulmonary rehabilitation could be used to prevent complications following surgery, it would have powerful benefits for both the individual and the NHS. It could happen whilst waiting for surgery.

Although pulmonary rehabilitation may reduce complications of surgery, there are no conclusive studies. Currently only 13 out of 224 pulmonary rehabilitation programmes in England and Wales accept patients about to undergo surgery. This feasibility study will help us design a full scale national trial. We will recruit people with COPD scheduled for major surgery. Participants will be randomly allocated to receive either a tailored course of pulmonary rehabilitation or receive normal treatment before surgery. This would happen during the normal waiting list time so surgery would not be delayed. We will find out the best measurements to collect, to help properly design the main trial.

Potential benefits include fewer complications after surgery, improved quality of life and quicker return to normal. This will also lead to better use of hospital resources, and considerable cost savings for the NHS. Implementation across the NHS could help many patients in a short time frame, as pulmonary rehabilitation programmes are already widespread.