Two people pointing to an apple, a weight, and a book with lungs on the cover

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:

  • doctors
  • nurses
  • physical therapists
  • respiratory therapists
  • exercise specialists
  • dietitians

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 in a Program

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.

Here are some details of the study:

  • 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.

In Summary

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Spitzer, K. A., Stefan, M. S., Priya, A., Pack, Q. R., Pekow, P. S., Lagu, T., . . . Lindenhauer, P. K. (2019, January 01). Retrieved from https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201805-332OC
  2. The Basics of Pulmonary Rehabilitation. (n.d.). Retrieved from https://www.lung.org/lung-health-and-diseases/lung-procedures-and-tests/pulmonary-rehab.html
  3. Gisler, S. (2018, December 04). Few COPD Patients Enroll in Pulmonary Rehabilitation, Study Reports. Retrieved from https://copdnewstoday.com/2018/12/04/few-copd-patients-enroll-pulmonary-rehabilitation-despite-proven-benefits-study/
  4. Wedzicha, J. A., Miravitlles, M., Hurst, J. R., Calverley, P. M., Albert, R. K., Anzueto, A., . . . Krishnan, J. A. (2017, March 01). Management of COPD exacerbations: A European Respiratory Society/American Thoracic Society guideline. Retrieved from https://erj.ersjournals.com/content/49/3/1600791
  5. Pulmonary Rehabilitation. (n.d.). Retrieved from https://www.nhlbi.nih.gov/health-topics/pulmonary-rehabilitation
  6. Spitzer, K. A., Stefan, M. S., Priya, A., Pack, Q. R., Pekow, P. S., Lagu, T., . . . Lindenhauer, P. K. (2019, January 01). Retrieved from https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201805-332OC

Comments

View Comments (13)
  • twovillages
    3 weeks ago

    The Pulmonary Lab exercises has given me more confidence in pushing exercise despite feeling SOB. I’ve learned that doesn’t mean my 02 saturation has dropped in many cases. The downside is the staff is very busy, and doesn’t have time to teach you how to use more exercise equipment besides the treadmill. I can join on my own later for $40.00 a month which is not bad. I’d feel ashamed to use my oximeter in front of the others if I was at the Silver Sneakers class. There are all kinds of pulmonary patients at the class. We even have prisoners come in in shackles for rehab. If I couldn’t drive my car I would have a real problem getting there twice a week. Give it a try if you have a chance. A friend got frightened, and dropped out after two visits. It’s sad because she would have learned the staff watch you so closely they make sure your health is not in danger.

  • Kerry
    3 weeks ago

    I was told by my health care provider here in Maine I could not go to pulmonary rehab til I prove I have been smoke free for 6 months.

  • twovillages
    3 weeks ago

    We have people in the pulmonary/rehab program here that are still smoking. They also refer you to a therapist if you’re feeling down.

    I was told that they don’t refer lung cancer patients to pulmonary rehab, but there are people that have both COPD, and lung cancer there. I’m wondering if it is an insurance issue, or the hospital policy. I know the hospital here will not do surgery for lung cancer if COPD is moderate or more. Other, larger hospitals have different policies, and do surgery.

  • Leon Lebowitz, BA, RRT moderator
    3 weeks ago

    Hi Kerry and thanks for your post. I’m sorry this is what is being told to you. It is possible (although I do not know for sure in your area), that those might be part of the guidelines for acceptance into a physician-referred pulmonary rehabilitation program. Are you actively working on stopping smoking? You may want to speak with your physician and/or rehabilitation program further to make certain you understand their guidelines. Please do check back and let us know how you’re doing. All the best, Leon (site moderator)

  • Marybetty
    3 weeks ago

    There is a wonderful on-line Pulmonary program available called LIFT Pulmonary Rehab. Just google LIFT…ITS 12.99 a month ….there are daily videos and are one on one led by certified Pulmonary therapists.
    EXCELLENT….they have helped me much more than going to regular rehab. You do them at home at your convenience.

  • Kathi MacNaughton author
    3 weeks ago

    That sounds like an interesting resource, Marybetty! Thanks so much for sharing.

  • chrissyinc4523
    3 weeks ago

    Hi, I went to rehab last year when I was diagnosed. I took advantage that my insurance paid for 36 sessions. I had to pay what the insurance didn’t pay, but it was well worth it. (I have a high deductible). I went twice a week for 2 hours. Very informative and I loved it. I wish there were classes offered at other places to keep up with all I accomplished. With the weather here in Nebraska its hard to get out and exercise like you can in the spring and summer.

  • chrissyinc4523
    3 weeks ago

    Also in class you had several nurses and exercise experts that monitored your oxygen, heart rate and blood pressure. The improvement that I made was fantastic. I can’t say enough about it.

  • Allyson.Ellis moderator
    3 weeks ago

    Thank you for sharing your experience of pulmonary rehab, chrissyinc4523! I hear what a positive experience it was for you. Surviving the long winter months in a state like Nebraska can be rough. Are you able to go anywhere to walk or exercise inside, like a gym or the mall? I hope you are able to continue using the skills you learned in pulmonary rehab to help manage your symptoms and continue feeling well! Keep up the great work! ~Allyson (COPD.net team)

  • pat bracken
    4 weeks ago

    I can’t say enough about Rehab . Here in Ireland it is an eight week course . Two hours a day , three days a week . One hour education , one hour exercise , both equally important . Knowing as much as you can about your disease and the drugs used to treat it is a great help in controlling it . The exercises help with your general fitness and mobility . In 2011 I was given just six months to live . I have no doubt that rehab and the 25% improvement in lung function it gave me , has played a major role in my still being here .

  • Leon Lebowitz, BA, RRT moderator
    4 weeks ago

    Hi pat bracken and thanks for your post. We are very glad you’ve provided your opinion and experiences with pulmonary rehabilitation in Ireland. It’s so good for us to hear about what is happening in other countries! So many of our members have had positive results with pulmonary rehabilitation programs and we’re glad you’ve shared your successful results as well. We’re glad to have you as part of our online community. All the best, Leon (site moderator)

  • Stretch22
    4 weeks ago

    In Northern Virginia, there is a great rehab program at Fairfax Hospital. However, it is my understanding that these programs aren’t available in many areas. It must come down to money and available resources, which is unfortunate.

  • Leon Lebowitz, BA, RRT moderator
    4 weeks ago

    Hi Stretch22 and thanks for this post and for sharing your familiarity with the program(s) in northern Virginia. We appreciate it. You make a good point, too. Not all areas have the same resources available for patients. It’s always a good idea (when looking for programs), to consult with one’s physician or local medical center. All the best, Leon (site moderator)

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