A COPD flare-up can leave you weaker, more tired and more worried about the next one. Many people ask when it is safe to start rehab again, and whether it is worth doing. The short answer from the guidelines is that sooner after discharge is usually suggested, but your own doctor decides what is right for you. This guide covers the timing guidance, what the research found, how to get ready, and how virtual pulmonary rehab fits in once your doctor says you can start.
When should I start pulmonary rehab after a COPD flare-up?
The American Thoracic Society and European Respiratory Society guideline on COPD flare-ups says: “we suggest the initiation of pulmonary rehabilitation within three weeks after hospital discharge.” It is a conditional recommendation, and the guideline rates the quality of the evidence as very low. The same guideline suggests not starting rehab during the hospital stay itself. (American Thoracic Society and European Respiratory Society, Management of COPD exacerbations: clinical summary)
A separate American Thoracic Society guideline on pulmonary rehab gives a strong recommendation, based on moderate quality evidence, for participation in pulmonary rehabilitation following hospitalization for a COPD flare-up. (American Thoracic Society, Pulmonary rehabilitation earns strong recommendation)
Guidelines describe groups of patients. They do not replace your doctor. How soon you start depends on how you are recovering, your oxygen needs and what else is going on with your health. Ask your doctor or the hospital team before you leave, or at your first follow-up visit: “When can I start pulmonary rehab, and can you send the referral?”
What does the research say about rehab after a flare-up?
The best known review is from Cochrane. It pooled 20 randomised trials with 1,477 people who had recently had a COPD flare-up. (Cochrane, Pulmonary rehabilitation for people who have been in hospital with an exacerbation of COPD)
What the review found
- Quality of life improved. On a standard breathing questionnaire, the average gain was larger than the smallest change that patients notice, and Cochrane rated the certainty of this finding as high.
- Walking distance improved by about 62 metres on the six-minute walk test, and Cochrane rated the certainty as high, though the results varied between studies.
- Hospital readmissions were lower in the pooled results, with moderate certainty. The authors described the effect on readmissions as inconsistent across trials.
- Few adverse events were reported during rehab, and the authors concluded that rehab after a flare-up is safe.
What the review could not show
The review did not find a clear difference in deaths, and none of the trials used death as their main measure. The trials also differed in how rehab was set up and when it started, so the exact best start date is not settled. That is why the guideline timing is a suggestion, and why a conversation with your own doctor matters.
What is a COPD flare-up?
The National Heart, Lung, and Blood Institute describes a flare-up as a sudden worsening of symptoms. Certain scents, dust or fumes can trigger one, and infections can too. (NHLBI, Living with COPD) If you want a refresher on what to do in the moment, read our guide on what to do when you feel short of breath.
How can I get ready while I recover?
Keep a short list within reach
The NHLBI suggests keeping your provider’s phone number, your hospital’s number and a contact who can drive you to care within reach. A simple card on the fridge or in your phone covers it.
Know when to get help
MedlinePlus says to get emergency care if you have severe symptoms, such as trouble catching your breath or talking, and to call your provider if your symptoms are getting worse or you have signs of an infection, such as a fever. (MedlinePlus, COPD) The NHLBI adds: seek emergency care if you have a severe flare-up.
Move gently once your doctor says it is okay
Do not start a hard exercise plan on your own right after a hospital stay. Once your doctor clears you, our guide to exercises for COPD explains safe ways to start and when to stop. A rehab team can set the pace for you.
What does rehab look like at Bloom after a flare-up?
MedlinePlus says pulmonary rehabilitation is a program that can include an exercise program, disease management training, nutritional counseling and psychological counseling. (MedlinePlus, Pulmonary Rehabilitation)
At Bloom Medical Group, every rehab session is one on one, each patient gets an individualized treatment plan, and we meet every patient where they are. That matters after a flare-up, when your energy and confidence may be lower than before. Sessions are live by video from home, run by licensed respiratory therapists and clinical exercise physiologists, and billed to insurance. Education sessions about your condition may include other patients. To see what a visit includes, read what happens in a pulmonary rehab session and the benefits of pulmonary rehab.
Bloom does not replace your doctor or your COPD medicines. Your doctor’s order and your plan’s rules decide when we can start. Our page on whether you need a referral for pulmonary rehab explains the usual steps.
Will my insurance cover rehab after a flare-up?
Coverage depends on your plan. Commercial plans write their own rules on referrals, prior authorization and visit limits, so call the number on your card, and read does insurance cover pulmonary rehab. If you want to know how Medicare treats rehab in general, see does Medicare cover pulmonary rehab. Bloom is not able to accept Medicare at this time.
Frequently asked questions
The American Thoracic Society and European Respiratory Society guideline suggests starting within three weeks after hospital discharge. It is a conditional recommendation based on very low quality evidence, so ask your own doctor when it is right for you.
A Cochrane review of 20 randomised trials found few adverse events reported during rehab and concluded that it is safe. Your doctor will tell you whether you are ready and whether anything about your health changes the plan.
Pooled results in a Cochrane review showed fewer hospital readmissions with rehab, with moderate certainty, but the authors described the effect as inconsistent across trials. It may help, and it is not a guarantee.
Many people can, once their doctor approves it. Bloom offers one on one rehab sessions live by video from home with licensed respiratory therapists and clinical exercise physiologists, billed to insurance. Your doctor’s order and your plan’s rules decide when you can start.
Bloom is not able to accept Medicare at this time. Bloom bills commercial insurance, and our team can check whether we can bill your plan before you start.
Next step
Not sure whether rehab fits you? Take our free 2 minute lung health assessment.
Ready to talk? Call 1-866-972-8228 or fill out the see if you qualify form.
This article is for education only and is not medical advice. Talk with your doctor about what is right for you.
Sources
- Cochrane, Pulmonary rehabilitation for people who have been in hospital with an exacerbation of COPD
- American Thoracic Society and European Respiratory Society, Management of COPD exacerbations: clinical summary
- American Thoracic Society, Pulmonary rehabilitation earns strong recommendation in new clinical practice guideline
- National Heart, Lung, and Blood Institute, Living with COPD
- MedlinePlus, COPD
- MedlinePlus, Pulmonary Rehabilitation
