OBJECTIVES: Pulmonary Rehabilitation (PR) is an effective intervention that is recommended by international guidelines for patients with chronic obstructive pulmonary disease (COPD) and other long-term respiratory conditions. However, PR programs are highly variable, and despite their clear clinical benefits, they remain underutilized. We aim to help improve the transparency for payers of international PR programs by comparing and summarizing various international PR guidelines and programs.

METHODS: A targeted literature review was conducted to retrieve PR guidelines from 9 countries (e.g., United States, Canada, United Kingdom, Australia) and key articles relating to the PR programs. We reviewed and compared eligibility, outcome assessment and referral/delivery recommended by the guidelines; and characteristics of PR programs.

RESULTS: The PR guidelines from all countries follow similar inclusion and exclusion criteria. “COPD or other respiratory conditions” and “unstable cardiovascular disease” are the most common inclusion and exclusion criteria, respectively. While patients may be referred to PR programs by different sources, the guidelines agree the eligibility evaluation should be performed by experienced general physicians or physicians specializing in pulmonary conditions. A multi-disciplinary team including pulmonologists and physiotherapists should deliver the program. Various measures are recommended to assess the four main outcome categories: exercise capacity, quality of life, shortness of breath and functional status. There was country-level variation in program characteristics, such as duration, setting and patient reimbursement. The PR programs generally last 4-12 weeks, take place in outpatient settings, and are reimbursed by the government or health insurance.

CONCLUSIONS: This study provides a preliminary overview of international PR guidelines and programs. We identified commonalities and differences about inclusion and exclusion criteria, outcome assessment categories, and program characteristics. The information may help streamline PR programs for greater payer understanding and encourage discussions to improve coverage and utilization of these important programs.