Pulmonary Rehab Can Help People With COPD, So Why Do So Few Get It?

Roughly 16 million Americans have chronic obstructive pulmonary disease (COPD), but only a fraction have access to a lifesaving treatment called pulmonary rehabilitation.

COPD is a family of diseases, including emphysema and chronic bronchitis, that make breathing difficult and worsens over time. COPD impacts more than 15 million Americans. There is no cure.

"A lot of these people, even despite being on inhaler and medication therapy still have lots of problems with shortness of breath while trying to do activities" said Aaron Bruns, MD, board certified physician in pulmonary sleep medicine and critical care at Franciscan Physician Network in Greenwood, Indiana. "It can cause a pretty significant effect on their quality of life. Some of them aren't able to do normal everyday activities, clean the house, go to the grocery, and it can be quite debilitating for them and the inhalers and other medications only do so much. So pulmonary rehab is a program designed for people with the goal of improving this shortness of breath in improving their quality of life."

Pulmonary rehab teaches patients to exercise, eat well and use medications appropriately in order to regain their strength. Patients attend on the average 26 to 36 visits in an outpatient setting.

“It helps with making a new lifestyle habit,” said Angela Byers, BSBA, RRT, Pulmonary Rehabilitation Coordinator at Franciscan Health Indianapolis and Mooresville. “Breathing retraining, cardio and weight programs along with education on their disease and proper medication use has shown to benefit our patients to improve their quality of life.”

Rebuilding Healthy Habits Through Pulmonary Rehabilitation

Pulmonary rehabilitation is not strictly exercise.

"in addition to the exercise portion of it there's various educational activities," Dr. Bruns said. "They will go through the patient's inhalers, make sure they're using them properly, make sure they understand why they have to do it, education about their lung disease in general nutritional information, a lot of these patients. They have trouble getting around. So they don't eat properly. Their nutrition status is not very good. Smoking cessation for patients who are still smoking to try and help them quit. In addition to the exercise in general. So a lot of programs will have a nutritionist there. Some of them will have. Mental health professionals, but that's not as common."

Pulmonary rehabiitation clinics can also foster socialization, as COPD patients often feel isolated. Pulmonary rehabilitation specialists also educate patients about their disease, medication use, oxygen use and action plans on when to call the doctor.

“We are here to help improve your breathing and quality of life,” Byers said. “We cannot cure your disease however, we can improve your stamina, help you understand how to cope better.”

Pulmonary Rehab After Hospitalization

Pulmonary rehab can help patients regain strength after a hospital stay.

A team from the University of Massachusetts studied data from almost 200,000 Medicare patients hospitalized for COPD in 2014. The findings were published May 2021 in the Journal of the American Medical Association.

Of that group, 1.5% (2,721 patients) began pulmonary rehabilitation within 90 days of leaving the hospital. In total, just over 38,300 patients died within one of year of discharge from the hospital.

The difference in the outcomes between those who had rehab within 90 days and those who didn't was striking: Within a year of discharge, 19.6% of the group who did not have early rehab had died, compared with 7.3% of patients who began rehab within 90 days.

"If this were a medication, it would be a blockbuster," said Dr. David Mannino, director of the Pulmonary Epidemiology Research Laboratory at the University of Kentucky, in Lexington. "The tragedy is that it's only available to such a small percentage."

Byers said pulmonary rehabilitation is worth the time investment for patients with COPD.

“In our pulmonary rehabilitation programs, we see tremendous improvement in our patients with COPD/IPF in their quality of life and overall health, improvement in strength and endurance and reduced admissions to a hospital,” she said.

Listen Now: Pulmonary Rehab

Greenwood, Indiana, pulmonologist Dr. Aaron Bruns explains the benefits of pulmonary rehab in the Franciscan Health DocPod podcast.