Tailoring Pulmonary Rehab to Close the COPD Gap, With Omid Pourshahid, MD | HCPLive
Barriers to Pulmonary Rehabilitation Uptake in COPD
Key Takeaways
- Only 1.5% of Medicare beneficiaries hospitalized for COPD started pulmonary rehabilitation within 90 days, and starting was associated with lower 1-year mortality (HR, 0.63).
- 72.8% of metropolitan beneficiaries with COPD live within 10 miles of a pulmonary rehabilitation center, compared with 11.3% of rural beneficiaries.
- Pourshahid proposed a matched-care pathway assigning patients to center-based, hybrid, or virtual pulmonary rehab; the criteria have not yet been prospectively validated.
Pourshahid described the gap as rooted in both health system and patient factors. Nationally, there is roughly 1 pulmonary rehabilitation center for every 6030 Medicare beneficiaries with COPD, and access varies sharply by geography.³ An analysis of 2018 Medicare data found 72.8% of metropolitan beneficiaries with COPD lived within 10 miles of a center, compared with 11.3% of rural beneficiaries.³
On the patient side, Pourshahid grouped the reasons patients do not start or complete pulmonary rehabilitation into physiologic, behavioral, and environmental categories.¹ Depression and current smoking consistently predict noncompletion, and transportation is the most consistent barrier to both starting and finishing a program.¹ Commute time, work shifts, and caregivers who must leave work to provide transportation can all affect participation, he said.
“It’s a lot easier to notice the physical limitations or desaturations rather than somebody feeling depressed,” Pourshahid said. “Screening positive for depression is not a reason to hold off on referral for pulmonary rehab, but it’s a good piece of information the pulmonary rehab team can plan the sessions around.”
He added brief screening questions take little time and allow the rehabilitation team to prepare for and address mood symptoms during sessions.
Editor’s note: Reported disclosures for Pourshahid include Boehringer Ingelheim Pharmaceuticals & Mylan Specialty.
References
Pourshahid O. Pulmonary rehabilitation is not one-size-fits-all: we need to tailor it for each patient (pro). Presented at: CHEST 2026; October 18-21, 2026; Phoenix, AZ.
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;323(18):1813-1823. doi:10.1001/jama.2020.4437
Malla G, Bodduluri S, Sthanam V, Sharma G, Bhatt SP. Access to pulmonary rehabilitation among Medicare beneficiaries with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2023;20(4):516-522. doi:10.1513/AnnalsATS.202204-318OC