Recovery after an acute episode or hospital admission

Many exacerbations can be treated at home. However some may require a hospital admission depending on severity. The main symptoms are breathlessness, tiredness and cough. What should you expect to see in your patient/client as they recover? Research evidence suggests that a referral to PR should be considered. NICE Quality Standards 2016 state that "starting a pulmonary rehabilitation programme within 4 weeks of hospital discharge after an acute exacerbation reduces the short‑term risk of hospital readmission, and improves the quality of life and the short‑term exercise capacity of people with COPD."*

  • The acute symptoms will improve considerably within the first week of treatment. However, a full recovery can take many weeks.
  • Breathlessness at rest or during light exercise, may take 2 or 3 weeks to settle. Patients/clients should be encouraged to increase their activity back to their normal levels.
  • Tiredness and breathlessness often go hand in hand. The tiredness should settle and improve as the person becomes more active.

 before seated, during calendar, after exercise

  • There is a natural reluctance to increase activity as the breathlessness and tiredness can provoke anxiety. Think about pacing activities and combinations of rest periods and activity through the day to build up confidence and reduce anxiety.
  • Everyone should be encouraged to increase daily activity. The person may need reassurance that breathlessness is not dangerous and as with tiredness, both can be countered by the increase in activity. Some patients/clients have to be persuaded that if they avoid activity this will only prolong their recovery and not aid it. An incremental increase in activity should be actively promoted.
  • Not all people have a cough, but when present, it may never completely settle. It is usually only a nuisance but patients/clients should be told to monitor the colour of their sputum. If it becomes darker and thicker this is a sign of possible infection.
  • All people should be given a simple list of things to look out for in case of another exacerbation. They should seek medical advice, to act on any increase in tiredness, breathlessness or increasingly green sputum.