Portugal's Respiratory Care Crisis: Doctors Demand Urgent Expansion of Home-Based Programmes

The Portugal National Health Service (SNS) is leaving 99% of patients who need respiratory rehabilitation without access to evidence-based treatment, despite mounting evidence that these programmes slash hospital admissions, emergency visits, and mortality rates. The Portuguese Society of Pneumology (SPP) is now calling for an urgent restructure that would shift programmes from hospital-only settings into primary care clinics, community networks, and patients' homes.

Why This Matters

• Only 1% of eligible patients currently access respiratory rehabilitation in Portugal, a fraction of the need.

• Proven cost savings: Programmes reduce emergency visits, hospital stays, and workplace absenteeism while improving quality of life.

• Decentralization push: Experts want programmes moved out of major urban hospitals and into local health centres and home-based care.

• The 1st International Congress on Respiratory Rehabilitation is scheduled for March 26–28, 2026, in Ílhavo, aiming to galvanize change.

The Treatment Portugal Is Failing to Deliver

Respiratory rehabilitation is a multidisciplinary, non-pharmaceutical intervention that combines aerobic and strength exercises, breathing techniques, nutritional support, and education on adopting healthier behaviors. It targets patients with Chronic Obstructive Pulmonary Disease (COPD) and other chronic respiratory conditions, offering them symptom relief and functional recovery that medications alone cannot provide.

Carlos Figueiredo, a member of the SPP Respiratory Rehabilitation Working Group, emphasized that the benefits are "diverse, significant, and multifactorial." Patients see improved symptoms, enhanced exercise capacity, fewer disease flare-ups, and reduced need for emergency room visits. The programmes also cut workplace and school absences, and preliminary data suggest lower mortality rates.

Yet despite this evidence, the model in Portugal remains anchored in specialized hospital units, most of them concentrated along the coast and in large cities. Figueiredo argues that this centralization severely limits accessibility, particularly for residents in rural and inland areas. "We need to move away from a model centered on specialized facilities," he said. "Primary care and community networks, even home-based services, can be an effective structure to increase access—provided there is adequate training and coordination with specialized centers."

What This Means for Residents

For patients living outside Lisbon, Porto, and other major urban hubs, accessing respiratory rehabilitation can mean traveling hours to a hospital, repeatedly, over weeks or months. Many simply give up. The 1% access rate reflects not just underfunding, but a structural mismatch between where services are located and where patients live.

The SPP's proposed shift would bring programmes closer to home. Training general practitioners, community nurses, and rehabilitation specialists in local health centres would allow patients to complete their programmes without the logistical burden. Home-based models, already tested successfully in Matosinhos (where access rates reached 15.4%, far above the national average), show that supervision can be effective even outside clinical settings.

Patients who complete respiratory rehabilitation typically experience:

• Better symptom control and quality of life

• Increased exercise tolerance, allowing a return to daily activities

• Fewer hospitalizations and emergency visits

• Lower risk of disease exacerbations

• Reduced absenteeism from work or school

The Economic Case: Saving the SNS Millions

Respiratory rehabilitation is recognized as one of the most cost-effective treatments available for chronic respiratory disease, surpassed only by flu vaccination and smoking cessation. Yet the SNS is spending far more on emergency care and hospital beds than it would on prevention and rehabilitation.

According to recent studies, a Local Health Unit (ULS) in an inland region found that 501 COPD patients made 905 emergency visits over seven years, costing the system €862,364. A simulated telerehabilitation programme would require an initial investment of just €4,305 in equipment and roughly €31,077 annually in staffing and materials—a fraction of the emergency care costs.

Programmes in low-resource settings cost as little as €646 per person, compared to €1,225 in specialized centers, while still delivering comparable outcomes. The SNS could save millions by expanding access and preventing the cascade of acute episodes that currently consume hospital resources.

Yet the economic impact may be underestimated. Cost-effectiveness analyses show that even scenarios preventing hospitalizations demonstrate value beyond direct cost savings, including quality of life improvements, productivity gains, and mortality reduction.

International Models: What Portugal Can Learn

Ireland stands out in Europe, with 65% of respiratory rehabilitation programmes based in the community rather than hospitals. The Irish system uses local "hubs" dedicated to COPD patients, offering diagnosis, monitoring, and rehabilitation in primary care settings.

The United Kingdom integrates respiratory rehabilitation into local NHS community services, with national frameworks to expand access and improve equity for disadvantaged groups.

Portugal has its own success stories. The Algarve Proximity Respiratory Rehabilitation Programme, developed in partnership with the University Hospital Centre of the Algarve and municipalities, delivers sessions in municipal sports halls, bringing care directly to communities. The programme won the Luísa Soares Branco Award for its innovative, decentralized approach.

In Matosinhos, a home-based maintenance programme designed by nurse Liliana Silva achieved a 15.4% access rate, more than 15 times the national average. The model emphasizes behavioral change and uses resources already available in patients' homes, reducing logistical barriers.

The reabilitAR programme, Portugal's first national home-based respiratory rehabilitation initiative, includes a 12-week intensive phase and a 40-week maintenance phase, combining home visits with telephone follow-up, exercise training, and self-management education.

Congress and Advocacy Initiatives in 2026

The 1st International Congress on Respiratory Rehabilitation (CIRR) will take place from March 26–28, 2026, at the Montebelo Vista Alegre Ílhavo Hotel. Organized by the SPP Respiratory Rehabilitation Working Group, the congress aims to share the latest scientific evidence, inspire more health professionals to specialize in the field, and channel profits toward SNS hospitals lacking rehabilitation equipment.

The National Respiratory Rehabilitation Day on April 21 is marked by a national awareness initiative launched by the SPP in partnership with the Polytechnic Institute of Leiria (ciTechCare), aiming to boost public and professional understanding of the intervention's value.

Additionally, the 4th Congress on Respiratory Care in Rehabilitation Nursing focuses on "Communicating, Motivating, and Empowering the Respiratory Patient," emphasizing patient autonomy and treatment adherence.

Barriers That Must Fall

Despite the evidence and the advocacy, barriers remain. Funding is the most cited obstacle. Without dedicated budget lines for community and home-based programmes, even well-trained professionals cannot deliver services sustainably.

Training gaps also persist. While hospital-based respiratory rehabilitation teams are often multidisciplinary and specialized, primary care staff may lack the specific competencies to deliver these programmes. The SPP is pushing for widespread training of General and Family Medicine doctors and rehabilitation interns, ensuring that expertise is distributed across the country, not concentrated in a handful of urban centers.

Public health literacy is another challenge. Many patients—and even some clinicians—remain unaware of respiratory rehabilitation's benefits. Without referrals from general practitioners or hospital discharge planners, patients never enter the system.

The Path Forward

The SPP is calling for political integration and financing to scale up respiratory rehabilitation nationwide. The shift from hospital-centric to community-integrated care requires coordination between specialized centers, primary care networks, and municipalities, supported by adequate funding and training infrastructure.

Telerehabilitation and home-based models offer a pragmatic route to expand access rapidly, particularly in underserved regions. These models do not replace hospital programmes but complement them, creating a continuum of care that meets patients where they are—literally and clinically.

The CIRR congress and National Respiratory Rehabilitation Day are expected to intensify advocacy efforts in 2026. The SPP is pushing for concrete commitments on funding, training, and decentralization of respiratory rehabilitation services across the SNS, with the goal of closing the current access gap and making respiratory rehabilitation a standard component of chronic disease management for eligible patients.