This information is for people with the lung condition chronic obstructive pulmonary disease (COPD), their families and carers.
An exacerbation of COPD – also known as a flare-up or ‘lung attack’ – can mean you need to be admitted to hospital. Here we use the term lung attack.
Being discharged from hospital and coming home successfully is important – it requires planning and organisation. No one wants to have to be readmitted later. This 18-point guide of things to think about when you are discharged will help you and your family get through this challenging time.
There is a checklist at the top of this page that corresponds to each point in the text. You can print this out, and use the checklist to work through the discharge process step by step and help you remember everything.
1. Has your family or carer been told about the date of discharge and are they ready for you to come home?
This may seem an obvious first step in the discharge process but sometimes it gets overlooked. There are arrangements that will need to be made, including making sure someone is at home on the discharge day, that the home is warm and that there is something to eat in the house.
2. Have arrangements been made with social services for your ongoing care?
Before you are discharged from hospital you should be asked whether you need any help at home. This question will probably be asked by an occupational therapist (OT) at first. This should happen while you are still in hospital.
You should then be referred to a social worker if necessary. The social worker may be attached to the hospital and she or he will set up a care package to help you and your family manage at home. The care may be delivered through your local council and may consist of a variety of help depending on what your local arrangements are. In some places a ‘re-ablement service’ may be provided free of charge for two to six weeks. This consists of care to help you to get back to your former level of fitness.
If you need a district or respiratory nurse to visit this will need to be organised by the hospital. You may be assigned an ‘early supported discharge’ team of nurses, who will visit you until you are fully recovered.
Sometimes a physiotherapist can be organised to visit you at home. This will also be organised by the hospital at first.
All of this takes time to organise and it may not all be in place by the time you go home. If you feel unsure about what services you can expect to receive, talk to your social worker. Remember to speak out if you have any concerns or are uncertain about any aspects of your care. If your family or carer cannot cope without help at home then do not leave hospital until your care package is fully set up.
3. Does your home need adaptations?
Your home may need some adaptations to help you cope, for example in the bathroom or to help you get upstairs. This will take time but your local council may be able to assist you. Talk to your social worker about asking the council for help. Explore this option first, but if the council cannot help then private companies will be able to quote for and undertake the work.
If your home is owned by the council and is no longer suitable for you, for example if your bathroom and your bedroom are on different floors and you cannot get up and down stairs, then you should apply directly to the council
for help.
4. Has your social worker checked whether you need special aids?
This can sometimes be very important depending on your mobility and that of the people or person caring for you.
- Is there a toilet on the same floor as the bedroom?
- Can you walk far enough to reach the toilet?
- Do you need a commode?
- Do you need a special tray to eat meals in bed?
- Is your condition likely to improve and if not, are adaptations to your home needed?
- Do you need a wheelchair?
All these things need to be thought through and decisions made. The NHS will supply some things, for example a commode, and the Red Cross will lend items.
5. Have arrangements been made about social care and/or meals being delivered?
Has anyone asked you if you need help with washing, dressing or feeding? This may not be necessary, but in case it is someone in social services should ask you, your family or carer about your needs. It may be that you need to arrange to have meals delivered for a while, or permanently. It is important that these arrangements are put in place before you leave hospital in order to avoid having to go back in.
6. Do you know how to manage your condition?
COPD is a long-term condition and you need to take control of how well you manage your illness. Many people do not know what COPD is or how it will affect them. As a result things can get suddenly worse and you don’t know what to do, or how to recognise the signs that trouble is on the way.
Hospital staff should talk to you about what COPD is and how to recognise the signs that your condition could suddenly flare up. Taking early action, as set out in a self-management plan, to avoid one of these ‘lung attacks’ should help prevent you having to be admitted to hospital again.
You should be given a self-management plan and an explanation of how self-management works. This plan covers all the areas of your care and should form the basis of your long-term treatment. The BLF produces a self-management pack – ask your health care professional about getting hold of one.
7. Has your inhaler technique been checked?
It is very important, especially after you have been in hospital, that you get the full effect of your medication. Many people who have been using an inhaler for years actually do not use it to the maximum benefit. Before you are discharged from hospital, your inhaler technique should be checked by a health care professional, who will show you how to get this right.
8. Has pulmonary rehabilitation been booked?
Pulmonary rehabilitation (PR) is a series of sessions for people with COPD. In these sessions you will learn a lot about COPD, how to exercise and how to get as well as possible. If you have COPD and have just been discharged from hospital, you may not be feeling very well. However, it is important for your recovery that you attend PR as soon as possible after a stay in hospital. Ask hospital staff about PR and whether it has been booked for you.
9. Has your walking been checked to ensure you can manage?
Many people with COPD are unsteady on their feet after a stay in hospital. Make sure that you can walk unaided or ask for an aid, like a walking stick or zimmerframe to help you. You may be breathless and therefore walk very slowly; that is not a problem, but it is important to stay balanced and avoid a fall.
10. Has the level of oxygen in your blood been checked to see whether you need a full assessment of your oxygen?
If the level of oxygen in your blood is low, you may need to have long-term oxygen therapy. The need for this treatment is not connected with your level of breathlessness. While you are in hospital, staff should check whether your level of oxygen is low using a pulse-oximeter (a clip on the end of your finger). If you need one, a date for an oxygen assessment should be made before you leave hospital. This is usually three weeks after you are discharged.
11. Have you been given antibiotics and/or steroids, as well as instructions on how to use them?
Each lung attack has an effect on your general health and lung function. You can spot an attack coming if your usual symptoms get worse for a few days. Treating these symptoms early can prevent you getting too ill and being readmitted to hospital. You should be given a standby course of antibiotics and steroids to keep at home in case of an attack. If your sputum (phlegm) turns yellow or green or is darker than normal, and you are more breathless, this could be a sign of an attack. Take your standby antibiotics, as prescribed. You may also need to use your inhaler more often.
12. Has your GP or doctors’ surgery been told about your discharge from hospital?
When you are discharged, you are often given a copy of a letter that has been sent from the hospital to your doctors’ surgery about your treatment. This letter can take a while to reach the surgery, so it is a good idea to ask for a copy and send it to your GP yourself. This will enable the doctor to visit you or make contact much sooner.
13. Have you had vaccinations for flu and pneumonia?
You should have an influenza (flu) vaccination once a year. If you have not had one in the last year, and are being discharged between September and March, you may need one. You should also check whether you need a vaccination against pneumonia. Your GP or local pharmacy will be able to advise you.
14. If you smoke, have you thought about quitting and been given help and advice?
There is help available if you want to quit smoking. Before you leave hospital ask for advice and about being booked on to a smoking cessation course.
15. Has anyone discussed with you how to manage depression and anxiety issues?
Many people who have a long-term condition, affecting the way they can live their life, experience depression and/or anxiety. If you think you might be experiencing these feelings, raise this while you are in hospital.
16. Have you thought about planning for end of life care?
While you are in hospital you might want to have a discussion about coming to the end of your life. It is always difficult to talk about this subject and each individual handles this in their own way. If you would like to talk to a nurse or doctor about the future and how to plan for it then hospital is a good place to start.
17. Has a post-discharge review been booked?
The hospital should fix an appointment for you to come to a clinic or surgery for a post-discharge review.
18. Have you been given information on patient support groups and the support provided by the BLF?
It can be very helpful to meet other people who are going through the same problems as you and share your experiences. The BLF runs a series of patient support groups throughout the UK called Breathe Easy. To find your nearest group, call the BLF Helpline on 03000 030 555 or look online. The helpline also offers free, confidential and impartial advice, information and support on a huge range of topics that relate to your lung health. Lines are open Monday to Friday, 10am to 6pm and calls are charged at a local rate.
Code: BK20
Version: 1
Last medically reviewed: December 2011
Due for medical review: December 2013
For references call 020 7688 5571
© British Lung Foundation 2011
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MSD provided funding to the British Lung Foundation for the production of this information. Its content was written and reviewed by independent experts.
