Supervised exercises and education can improve lung function and quality of life in COPD.

These therapies are typically offered in hospital, but their benefits are progressively lost once patients finish a course.

Researchers from the National Institute for Health Research's health technology assessment programme looked at whether such programmes could be offered in the community.

'A community-based programme could potentially produce a change in lifestyle and more sustained benefits,' lead researcher Dr Rod Lawson said.

The researchers compared hospitaland community-based programmes offered to 240 patients with COPD. There were no significant differences between the groups in improvements in exercise capacity.

Leicestershire GP and Primary Care Respiratory Society member Dr Dermot Ryan said the evidence was clear the programmes can be delivered with equal effect in the community.

'It is a community service which can and should be developed under practice-based commissioning, providing great benefit to the patients who much prefer to have the service delivered close to home,' he said.

Dr Lawson and his team did not find any evidence that community provision of pulmonary rehabilitation was more cost-effective than hospital provision. Optimum service should, they said, depend on local factors.

'While group pulmonary rehabilitation was effective in either setting, many people could have benefitted but were unwilling to take up the treatment,' they said.

'Increasing uptake has large potential for improving public health, and is likely to be more important than minor changes in the programme itself.'

• Health Technology Assessment Online 2010