Research published November 12, 2018, in the Annals of the American Thoracic Society found that only 1.9 percent of patients hospitalized for COPD received pulmonary rehabilitation within six months of being discharged. The authors stress that these 6- to 12-week programs are much more accessible now that Medicare offers coverage for these services. Researchers examined the Medicare records of 223,832 patients who were hospitalized with COPD in 2012. That number represented all COPD hospitalizations among traditional Medicare beneficiaries that year. Only 4,225 patients underwent pulmonary rehab within six months of being discharged. That number rose slightly to 6,111 (2.7 percent) when researchers checked patients 12 months after discharge. “These are pitifully small numbers when we think of all who would benefit,” says the study’s principle investigator, Peter Lindenauer, MD, a hospitalist at Baystate Medical Center in Springfield, Massachusetts, and the director of the Institute for Healthcare Delivery and Population Science at the University of Massachusetts Medical School in Worcester. “We know patients with COPD end up being very sedentary because of shortness of breath, and then there’s a vicious cycle of shortness of breath leading to more sedentariness and deconditioning, which only worsens the shortness of breath,” he says. “Pulmonary rehabilitation gives people the tools to manage the disease themselves.” So why do so few patients use pulmonary rehab? Researchers are unsure if it’s due to a lack of patient referrals from doctors or if patients simply choose not to attend. The authors note that of those who started the sessions, more than half completed 16 sessions, and Medicare will typically pay for up to 36 sessions.
Survey: A Majority of Patients Don’t Hear About Pulmonary Rehab
To get a better understanding of patient attitudes toward pulmonary rehabilitation, the American Thoracic Society commissioned a recent survey of 500 patients, not only including those with COPD but those with pulmonary hypertension, interstitial lung disease, and other chronic pulmonary disorders. Four out of 10 polled did not realize how deadly chronic respiratory diseases can be. The American Thoracic Society says that these conditions, with COPD being the most common, are the third leading cause of U.S. deaths after heart disease and cancer. Almost two-thirds of participants had never heard of pulmonary rehabilitation. Most, however, had heard of other treatments: 70 percent knew of oxygen therapy and medicinal interventions such as long- and short-acting inhalers. While 38 percent of respondents had heard of pulmonary rehab, only 29 percent completed a program. According to the survey, the top reasons given for not participating in or completing a pulmonary rehab program were:
Too difficult to travel there (36 percent)Expense (28 percent)Difficulty leaving home because of breathing problems (27 percent)Emotionally too difficult, including feelings of embarrassment or anxiety (27 percent)
Even Severe COPD Patients Can Benefit
Chris Garvey, a nurse practitioner at the University of California in San Francisco who has been coordinating pulmonary rehabilitation programs for over 25 years, says that patients and providers have to figure out ways to get beyond these barriers. “The evidence has grown to establish pulmonary rehabilitation as the standard of care to improve shortness of breath, functional capacity, ability to exercise and be active, as well as quality of life and mood, including depression and anxiety in persons with chronic lung disease,” says Garvey. Garvey stresses that even patients with severe COPD can benefit from rehabilitation. She says that those with more severe forms of the disease who may be assigned for lung transplant are normally required to do pulmonary rehabilitation so they will do better during and following the surgery. “It’s a very rare patient who wouldn’t benefit,” she says. “They might not have a complete reversal of their symptoms or complete achievement of full function, but it’s reassuring that they can improve and be more comfortable and somewhat more independent. There is almost always benefit to achieve.”
A Need to Educate Patients and Providers
Garvey believes that part of the reason so few patients get involved may lie with primary care providers. “They need to know that pulmonary care rehabilitation is safe, effective, and is often covered by the patient’s insurance [or Medicare],” she says. Garvey adds that patients are often treated with long-acting maintenance inhalers instead of pulmonary rehabilitation. “The rehabilitation is ultimately more helpful in terms of reversing frailty and reversing musculoskeletal dysfunction,” she says. For patients who want to learn more about pulmonary rehabilitation, Garvey recommends visiting the website Live Better With Pulmonary Rehab, the American Thoracic Society’s initiative to build awareness of pulmonary rehabilitation. The site can help patients find a rehab program near them and answers many questions about how the program works.
