Pulmonary Rehabilitation -- A Valuable, But Underused Tool for Better COPD Management
Have you ever heard of a COPD management program called "pulmonary rehabilitation," or pulmonary rehab, for short? If not, you're definitely not alone. A recent study1 found that the majority of COPD patients were not familiar with pulmonary rehab or how it might benefit their respiratory health. So, how does such a valuable tool go so unnoticed?
Let's take an in-depth look at pulmonary rehabilitation for COPD.
What is pulmonary rehab?
The American Lung Association defines pulmonary rehab as: "a program of education and exercise to increase awareness about your lungs and your disease.2 "
The goal with such a program is to learn more about your condition and how to best manage it and maintain a stable health status. Besides group classes and support sessions, you'll also be taught how to exercise safely to build strength and endurance.
A pulmonary rehab team can include the following health care disciplines:
- physical therapists
- respiratory therapists
- exercise specialists
Most often, pulmonary rehab programs are based in hospitals or clinics, although in some cases, the services may be available in home health care. There is good news if you are on Medicare. Pulmonary rehab has been a covered benefit since 2010. If you are not old enough yet for Medicare, then there's still a good chance that your health insurance will cover it.
These programs offer3:
- physical/exercise training
- self-management advice
- nutritional counseling
- emotional support
What are the benefits of pulmonary rehab?
Pulmonary rehab is generally used for people who have a lung disease and who have frequent shortness of breath that interferes with daily activities. Sound familiar? COPD is one of the most common diagnoses for those in pulmonary rehabilitation programs, though it is not limited to COPD patients.
Guidelines published by the European Respiratory Society4 recommend that pulmonary rehab is started within 3 weeks after hospitalization for COPD. The authors state that such programs reduce further hospitalizations and improve quality of life.
Pulmonary rehab won't cure your disease or put you into remission. But it can produce the following benefits5:
- Better quality of life
- Improved ability to function in your daily life
- Better exercise tolerance
- Lessening of COPD symptoms
- Reduced anxiety and depression
In short, this program won't take away all your breathing problems. But it can help you make the best of the limited lung function you do have.
Few COPD patients actually participate
So, back to my original question at the start of this post... was pulmonary rehab ever recommended for you since your COPD diagnosis? Had you even heard of it before reading this article? I have to tell you, in all the years my mother suffered from COPD, not once was pulmonary rehabilitation ever mentioned to her or to me.
Apparently, this is not unusual. In a study published in January 2019 in the Annals of the American Thoracic Society,researchers found that pulmonary rehab is significantly underused. In fact, they learned that 62% of the people studied had never even heard of it.6 This is especially surprising, given Medicare's support for this treatment tool.
- Health care claims data for 223,832 Medicare beneficiaries that had been hospitalized for COPD in 2012 was used.
- Most participants had a primary diagnosis of COPD; others had COPD as a secondary condition.
- Study looked at whether pulmonary rehab was started at all and if so, how long it lasted.
Here's what the researchers found when they examined the health care claims:
- Only 1.9% of all patients who'd been hospitalized for COPD received pulmonary rehab within the next 6 months.
- 2.7%, a slight increase, did receive rehab within 12 months of hospitalization.
- Those who did get it tended to be on supplemental oxygen therapy.
- Other factors that were associated with starting pulmonary rehab within 6 months: being white, younger and of higher socioeconomic status.
- Factors that were associated with not getting rehab: being a smoker or living more than 10 miles from the nearest program.
Medicare will pay for up to 36 sessions of pulmonary rehab. The study found that more than half of those studied who started pulmonary rehab completed at least 16 sessions. A mere 10% completed 35 or more sessions. So, it seems that even when pulmonary rehab was started, it was not always fully utilized.
Tell us about your experience (or lack thereof) with pulmonary rehabilitation in the comments below.
More research is needed
More study is needed to understand why a valuable tool for respiratory health like pulmonary rehab is so underused in people who have COPD. Since clinical practice guidelines encourage it and insurance usually covers it, why is it not used more? Especially since there are so many concrete benefits?
Perhaps the accessibility of such programs is an issue for some people. Or, the burden of transportation to facilities is a burden on caregivers or patients themselves? Maybe it's the lack of information that health care professionals share with their COPD patients?
If pulmonary rehab is something you're interested in, I encourage you to discuss with your healthcare team whether it might be right for you.
Do you live with any sleep disorders (eg. insomnia, RLS, sleep apnea) in addition to COPD?