07 Apr Pulmonary Rehabilitation – Live Better and Live Longer
Over 16 million people in the US have COPD1 and up to 60% of COPD cases go undiagnosed2. According to the World Health Organization, COPD is the third leading cause of death globally.3 COPD continues to be a leading cause of disabling symptoms and suffering. Pulmonary Rehabilitation (PR) is the standard of care for persons with COPD and is associated with improved physical function, symptoms, mood, and quality of life. Although PR is well established as a highly effective treatment for COPD and other chronic respiratory diseases,4,5 in the United States only 3–4% of Medicare beneficiaries with COPD receive PR.6 Similarly low estimates exist for the rest of the world.7
A recent study by Peter Lindenauer and colleagues found that, in persons hospitalized due to acute exacerbation of COPD, PR within 3 months of discharge vs. later or no PR, was associated with a highly significant lower risk of mortality at 1 year (hazard ratio, 0.63; i.e., a 37% lower risk of death over the year following discharge).8 The study utilized claims data of 197,376 Medicare beneficiaries discharged after hospitalization for COPD.8 The findings support PR as a high priority following hospitalization for COPD.
Patients suffering from COPD should know that PR not only has potential for helping them feel better and being more independent but also to live longer. We are asking for your support in communicating these important findings of improved survival after PR to providers and patients. Thank you in advance for your help and collaboration.
- Allergy & Asthma Network
- Alpha 1 Foundation
- American Association of Cardiovascular Pulmonary Rehabilitation
- American Association for Respiratory Care
- American Academy of Allergy, Asthma & Immunology
- American Lung Association
- American Thoracic Society
- CHEST/American College of Chest Physicians
- COPD Foundation
- Dorney-Koppel Foundation
- LAM Foundation
- Lung Transplant Foundation
- phaware Global
- Pulmonary Education and Research Foundation (PERF)
- Pulmonary Fibrosis Foundation
- Respiratory Compromise Institute
- Respiratory Health Association
- Right2Breathe
- US COPD Coalition
- COPD. Centers for Disease Control and Prevention. Published June 6, 2018. Accessed December 28, 2020. https://www.cdc.gov/copd/index.html
- Martinez C, et al. Undiagnosed Obstructive Lung Disease in the U.S. Annals ATS. 2015;(12):1788-1795.
- https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death Accessed February 7, 2021.
- Spruit MA, et al; ATS/ERS Task Force on Pulmonary Rehabilitation. An official ATS/ERS statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-e64. doi:10.1164/rccm.201309- 1634ST
- McCarthy B, et al. Pulmonary rehabilitation for COPD. Cochrane Database Syst Rev. 2015;2(2):CD003793. doi:10. 1002/14651858.CD003793.pub3
- Nishi SP, et al. Pulmonary rehabilitation utilization in older adults with COPD, 2003 to 2012. J Cardiopulm Rehabil Prev. 2016;36(5):375-382. doi:10.1097/HCR.0000000000000194
- Desveaux L, et al. An international comparison of pulmonary rehabilitation: a systematic review. COPD. 2015;12(2):144-53. doi: 10.3109/15412555.2014.922066
- Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA. 2020 May 12;323(18):1813-1823. doi: 10.1001/jama.2020.4437.
Brenda Goorhouse
Posted at 10:54h, 28 JuneOne reason people don’t attend PR is because there are too few sites that offer it. I live 25 miles from the closest PR site, and the program requires 2-3 sessions per week. I would love to attend (and felt SO much better when I did!), but I live on a fixed income and the cost of getting to the therapy is just too much for me. And I hear this complaint from many others I’ve talked to about it. We need more medical facilities to step up and offer this therapy!
PERF
Posted at 15:42h, 28 JuneDear Brenda,
Thank you for your insightful comment. You’ve identified the key problem that pulmonary rehabilitation faces. The primary reason for poor availability can be traced back to poor reimbursement by insurers and the government for pulmonary rehabilitation services. Programs are struggling to remain viable and large swaths of the United States lack conveniently located programs. Members of PERF and other patient-advocacy organizations are working on ways to correct this trend, but it is slow going.
With some hesitation, I’ll mention that “virtual” rehabilitation… programs that utilize videoconferencing tools to deliver pulmonary rehabilitation services are starting to be explored. At present, issues of safety, effectiveness and variability in program quality need to be worked out. I’d suspect that, a person like you, who has participated in pulmonary rehabilitation in the past, might well benefit from the “right” virtual program.
In the meantime, we’ve provided a link to a directory of pulmonary rehabilitation programs from LiveBetter.org, hoping there is one near you that you’ve missed.
Best wishes.
Rich Casaburi, President, PERF