For patients with chronic obstructive pulmonary disorder (COPD), pulmonary rehabilitation can significantly improve well-being. But according to a recent study, few people with COPD get the benefits of multifaceted rehabilitation programs that combine exercise training, nutritional counseling, education, and support.
The research was published on November 12, 2018 in Annals of the American Thoracic Society It found that only 1.9 percent of patients hospitalized with COPD received pulmonary rehabilitation within six months of being discharged from hospital. The authors stress that these 6- to 12-week programs are more easily accessible now that Medicare offers coverage for these services.
Researchers examined the medical care records of 223,832 patients hospitalized with COPD in 2012. This number represents all COPD hospitalizations among recipients of conventional health care that year. Only 4,225 patients underwent pulmonary rehabilitation within six months of discharge from hospital. That number rose slightly to 6,111 (2.7 percent) when researchers screened patients 12 months after discharge.
“These are pathetically small numbers when we consider everyone who would benefit,” says the study’s lead researcher. Peter Lindenauer, MDa hospital physician at Baystate Medical Center in Springfield, Massachusetts, and director of the Institute for Health Care Delivery and Population Sciences at the University of Massachusetts Medical School in Worcester.
“We know that patients with COPD end up being very stable with dyspnea, and then there is a vicious cycle of dyspnea that leads to more stability and deconditioning, which only worsens dyspnea,” he says. “Pulmonary rehabilitation gives people the tools to manage disease on their own.”
So why do so few patients use pulmonary rehabilitation? Researchers are unsure whether this is due to a lack of patient referrals from physicians or if patients simply choose not to attend.
The authors note that of those who started sessions, more than half completed 16 sessions, and Medicare will typically pay up to 36 sessions.
Survey: The majority of patients do not hear about pulmonary rehabilitation
To gain a better understanding of patients’ attitudes toward pulmonary rehabilitation, the The American Thoracic Society commissioned a recent survey 500 patients, not only those with COPD but those with pulmonary hypertension, interstitial lung disease and other chronic lung disorders.
Four out of 10 respondents did not realize the severity of chronic respiratory disease. The American Thoracic Society says that these conditions, with COPD being the most common, are the third leading cause of death in the United States after heart disease and cancer.
Nearly two-thirds of the participants had not heard of pulmonary rehabilitation. However, most have heard of other treatments: 70 percent of them know about oxygen therapy and medical interventions such as long- and short-acting inhalers.
While 38 percent of respondents have heard of pulmonary rehabilitation, only 29 percent have completed the program.
According to the survey, the top reasons given for not participating in or completing a pulmonary rehabilitation program were:
- It is very difficult to travel there (36 percent).
- Expenses (28 percent)
- Difficulty leaving the house due to breathing problems (27 percent).
- Emotionally very difficult, including feeling embarrassed or anxious (27 percent)
Even severe COPD patients can benefit
Chris GarveyM., a nurse practitioner at the University of California, San Francisco who has coordinated pulmonary rehabilitation programs for more than 25 years, says patients and providers must find ways to bypass these barriers.
“Evidence has grown to establish pulmonary rehabilitation as a standard of care for improving shortness of breath, functional ability, exercise capacity and activity, as well as quality of life and mood, including depression and anxiety, in people with chronic lung disease,” Garvey says.
Garvey stresses that even patients with severe COPD can benefit from rehabilitation. She says those with more severe forms of the disease who may be assigned a lung transplant are usually required to undergo pulmonary rehabilitation so that their performance improves during and after surgery.
“It’s a very rare patient who won’t benefit from it,” she says. “They may not have a complete reversal of their symptoms or a full realization of their function, but it is reassuring that they can improve and be more comfortable and somewhat more independent. There is always a benefit to be gained.”
The need for patient and provider education
Garvey thinks part of the reason why so few patients share may be with their primary care providers. “They need to know that pulmonary care rehabilitation is safe, effective, and often covered by patient insurance. [or Medicare]”, she says.
Garvey adds that patients are often treated with long-acting inhalers rather than pulmonary rehabilitation. “Rehabilitation is ultimately more beneficial in terms of reversing weakness 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 rehabilitationAmerican Thoracic Society initiative to build awareness of pulmonary rehabilitation. The site can help patients find a rehabilitation program near them and answer many questions about how the program works.