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COPD with a barrier to centre-based pulmonary rehabilitation — SCE Respiratory MCQ

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HardPulmonary RehabilitationCOPD with a barrier to centre-based pulmonary rehabilitationSCE Respiratory

A 69-year-old man with smoking-related COPD remains limited by breathlessness despite optimised inhaled therapy and satisfactory inhaler technique. Post-bronchodilator FEV1 is 39% predicted and his MRC dyspnoea grade is 4. He has been clinically stable for 8 weeks and has no unstable cardiovascular or musculoskeletal comorbidity. He is offered directly supervised centre-based pulmonary rehabilitation but cannot attend because the nearest programme requires an unmanageable journey. The service also provides an evidence-based home programme using written materials and scheduled telephone and video supervision. During a video consultation, he completes a remotely supervised 1-minute sit-to-stand test without an adverse event. He has not undergone an in-person exercise assessment. Which pulmonary rehabilitation plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange an in-person multisystem assessment with an ISWT or 6MWT, then enrol him in the supported home programme with individually progressed aerobic and resistance training.

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

He has symptomatic, functionally limiting COPD and is eligible for pulmonary rehabilitation. Directly supervised centre-based rehabilitation should be the primary offer, but inability to attend should trigger an evidence-based alternative rather than loss of access to structured rehabilitation. Crucially, the delivery model does not remove the requirement for an in-person multisystem safety assessment and validated measurement of exercise capacity. An ISWT or 6MWT can support individualised exercise prescription and provide a baseline outcome measure. Remotely supervised functional tests have not been established as safe or valid for this purpose, and sit-to-stand testing is complementary rather than a replacement for a validated walking test. The subsequent programme should retain core components, including individually prescribed and progressed aerobic and resistance training. A is incorrect because the remote sit-to-stand result is insufficient for safety assessment or exercise prescription. B incorrectly treats centre attendance as a prerequisite; supported alternative models should be offered when centre-based rehabilitation is declined or inaccessible. C improves supervision but still substitutes a functional test for a validated exercise-capacity test. E is unnecessary: CPET is an acceptable assessment in selected cases but is not routinely required when a validated field walking test is appropriate.

Reference: British Thoracic Society quality standard for pulmonary rehabilitation (June 2026) — https://www.brit-thoracic.org.uk/document-library/quality-standards/pulmonary-rehabilitation/bts-quality-standard-for-pulmonary-rehabilitation/ British Thoracic Society Clinical Statement on pulmonary rehabilitation (2023) — https://thorax.bmj.com/content/78/Suppl_5/s2