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Pulmonary Rehabilitation Is Difficult For Millions Of Americans To Access
Pulmonary rehabilitation, an essential component of care for patients with chronic respiratory conditions, is difficult for millions of Americans to access, a new Yale-led study reveals. The findings, researchers say, reveal geographic regions where this type of care is most lacking and illustrate the potential for telemedicine in helping to bridge this gap.
The study was published Feb. 5 in JAMA Network Open.
Pulmonary rehabilitation is a multidisciplinary program that incorporates exercise and strategic techniques to improve quality of life and overall health for patients with respiratory conditions like chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pulmonary hypertension. Programs typically include a structured exercise component supervised by nurses and/or exercise specialists, as well as educational sessions that teach patients techniques that can help them better manage their illness day to day, such as energy conservation, supplemental oxygen therapy, and methods for capitalizing on periods of higher energy.
"It has been demonstrated across almost the entirety of pulmonary medicine to improve patient health and patient-reported outcomes," said Dr. Peter Kahn, a pulmonary and critical care fellow at Yale School of Medicine and lead author of the study. "Through these programs, patients not only gain a more comprehensive understanding of their condition, but also improve their exercise tolerance in a meaningful way."
However, despite the demonstrated importance of critical pulmonary rehabilitation, many people in the United States must travel long distances to utilize programs.
For the study, researchers used massive geographic data sets and computational infrastructure to compute hundreds of millions of travel times.
"Technologies enabling travel time computations at a massive scale are not just innovative but transformative, providing us with nuanced insights into national data sets previously unavailable to researchers," said senior author Dr. Walter Mathis, a psychiatrist and health services researcher at Yale School of Medicine.
While around 80% of Americans live within a 30-minute drive of a pulmonary rehabilitation program, the researchers found, over 14 million people — mostly living in the country's western and mid-western regions — must travel more than an hour away for access to their nearest offering.
They also uncovered racial disparities in access to pulmonary rehabilitation. For example, nearly 30% of the American Indian and Alaska Native population lives more than an hour away from the closest program.
"Access to programs within a reasonable amount of travel time is key," said Kahn. "First, many patients with chronic respiratory conditions require oxygen supplementation. Long commutes may mean they have to transport multiple oxygen tanks or battery supplies, which may cause patients to forgo the treatment. Second, because exertional intolerance is a symptom of these diseases, long travel can be incredibly taxing and also serve as a barrier to participation."
Telemedicine and virtual rehabilitation can help bridge this gap need in the short term, said Kahn, though the long-term effectiveness of this approach across different diseases still needs additional evaluation.
Helping patients in the long term will require more accessible in-person rehabilitation options, he added. That will require collaboration between policy makers and health care providers and different approaches to insurance reimbursement.
"Insurance payers, both government and private, do not sufficiently reimburse pulmonary rehabilitation programs for the people, equipment, and supplies needed to effectively run them," said Kahn. That represents a barrier to offering these programs. Of equal importance, insurance limits how many rehabilitation sessions a patient can attend, he added.
"If you're someone with a chronic respiratory condition like advanced COPD, you really need ongoing therapeutic sessions," he added. "But right now, payers limit patients to a small number of lifetime sessions relative to the long-term burden of the disease. And that needs to change."
Expert Reveals What Is Causing Your Cough That Won't Go Away- And How To Get Rid Of It For Good
It may seem like everyone you know is sick - with people calling out of work and friends canceling plans.
With the recent spikes in flu, Covid, and RSV as part of America's tripledemic, more and more people have found themselves fighting a runny nose or sore throat.
For many, these symptoms are accompanied by a pesky cough that just won't go away.
However, doctors have revealed what a cough actually means and tips for getting rid of it for good.
Dr Malathy Munisamy, a clinical research physician at MAC Clinical Research in the UK, said that while coughing can be annoying, it's a normal defense mechanism.
'A cough is simply the body's natural response to any irritations within the airways,' he said.
The US is in the midst of a surge in flu and cold cases. However, a pesky cough could be a sign of several different conditions, doctors warn
This could include germs, mucus, and dust, among other pollutants.
Dr Munisamy said: 'Standard coughs, which are often "harmless," settle on their own within a couple of weeks.'
However, those that linger could be a sign of a cold, the flu, or a serious infection like pneumonia.
While the average cough lasts for about 18 days following an infection, Dr Munisamy groups coughs into three categories based on how long they persist for: acute, sub-acute, and chronic.
An acute cough is one that's lasted for less than three weeks. In many cases, this lingering cough could be due to a run-of-the-mill cold, case of the flu or post nasal drip caused by allergies or a virus.
Post-nasal drip is when excess mucus builds up in the back of the throat and drips down. This may make you feel a tickle in the back of your throat, cause frequent swallowing, hoarseness, nausea, and a constant urge to clear your throat.
It can also lead to a chronic cough.
Dr Munisamy recommends using a steroid-based nasal spray like Afrin or Flonase to ease inflammation in the nose and reduce mucus.
The color of your snot can give you a few hints as to why you have a runny nose. In some cases, for instance when it is clear, it is relatively harmless and usually caused by pollen allergies. If it is black, though, it could signal that you have been infected by a deadly fungus
He said: 'As this cough is caused by a virus, rest, hydration, paracetamol, ibuprofen or cold relief medication are usually effective treatments.'
But steer clear of antibiotics in these cases: 'If you are taking antibiotics for viruses, these will not work and could lead to bacterial antibiotic resistance.'
A cough lasting three to eight weeks is known as a sub-acute cough.
Dr Munisamy said this could be a sign of chest infections like bronchitis, whooping cough, or pneumonia.
Bronchitis is an infection of the large airways, also known as the bronchi, that travel between the windpipe and the smaller airways.
The Mayo Clinic states while the initial disease usually resolves within a week to 10 days, the cough could linger for several weeks and antibiotics are not usually recommended.
Whooping cough, also known as pertussis, is a highly contagious infection characterized by a severe, hacking cough and is treated with a course of antibiotics. Doctors say it is very important to treat whooping cough early, before coughing begins, because delay in treatment will render it ineffective.
And pneumonia inflames the lungs' air sacs, which could cause them to fill with fluid. Some forms of pneumonia can be treated with antibiotics, while some can be prevented through vaccinations.
Along with a cough that can produce phlegm - a type of mucus that comes from the lungs and the throat - symptoms include chest pain when you breathe or cough, confusion, fatigue, fever, chills, low body temperature, nausea, and shortness of breath.
The above shows the common symptoms (green check), occasional and possible symptoms (orange circle) and the symptoms that never occur (red cross) with the common cold, flu and Covid
Dr Munisamy said: 'Chest infections can either be viral or bacterial, and each requires different treatment.
'Either antiviral medication or an antibiotic can be prescribed alongside the usual advice of rest, paracetamol, and hydration.'
Treating all of these respiratory illnesses early can help reduce the chance of developing a persistent cough that lasts well after other symptoms subside.
The doctor also noted that a sub-acute cough could also be a sign of Covid-19. He said a hallmark of the Covid cough is one that's new and continuous, meaning it's lasted for more than an hour or you have three or more coughing episodes within 24 hours.
Treatments for Covid include many of the same as those for a cold and the flu, plus the medication Paxlovid, which can be prescribed by a doctor.
If you've been coughing for more than eight weeks, Dr Munisamy warns you could be suffering from a chronic cough, which could be a sign of a more serious condition.
One of these is chronic obstructive pulmonary disease (COPD), an inflammatory lung disease that causes obstructed airflow.
According to the Mayo Clinic, this leads to difficulty breathing, as well as wheezing, chest tightness, frequent respiratory infections, lack of energy, unintended weight loss, and swelling in the ankles, feet, or legs.
Smoking is the most significant risk factor for COPD.
According to the World Health Organization, COPD is the sixth-leading cause of death across the world. It affects 16 million Americans.
There is currently no cure for this progressive illness, but there are lifestyle changes which can help ease symptoms and aim to prolong life expectancy,' Dr Munisamy said.
'These include stopping smoking, bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and oxygen therapy.'
He also points to idiopathic pulmonary fibrosis (IPF) as a potential culprit for a chronic cough, which causes scarring of the lungs.
Though the condition is progressive, Dr Munisamy recommends using supplemental oxygen and, in extreme cases, lung transplantation to reduce symptoms.
A Chronic cough could also a sign of lung cancer, the deadliest form of cancer, according to the National Cancer Institute (NCI).
It accounts for one in five cancer deaths.
Standard lung cancer treatments include a combination of chemotherapy, radiation, and surgery.
As a general rule of thumb, Dr Munisamy said if your cough has lasted any longer than three weeks, it's time to see a doctor.
He added: 'Any cough with associated worrying or severe symptoms such as coughing up blood, hoarseness of the voice, shortness of breath, fever, weight loss, trouble swallowing, or vomiting, should immediately be assessed by your doctor.'
DWP Offers Over £8,000 A Year To People With These Conditions - Full List Of Eligibility
Personal Independence Payment (PIP) can help with extra living costs if someone has both a long-term physical or mental health condition or disability and difficulty doing certain everyday tasks or getting around because of their condition.
People who have respiratory conditions, such as severe asthma or sleep apnoea could be eligible for the benefit.
The benefit is administered by the Department for Work and Pensions (DWP) and is available to people who are 16 and over, but under state pension age (which is currently 66).
The payment can boost one's income by thousands of pounds a year, and they can be eligible whether they are in work or not.
There are two parts to PIP - a daily living part - if one needs help with everyday tasks, and a a mobility part - if one needs help with getting around.
Whether someone gets one or both parts and how much they get depends on how difficult they find everyday tasks and getting around.
There are two rates for each part - standard or enhanced - depending on the level of one's needs.
The weekly rates are:
This means claimants could get up to £748.58 a month if they get the higher weekly rates for both parts, or up to £8,983 a year. PIP is paid every four weeks.
As the cost-of-living crisis continues, Britons are urged to check what benefits they may be entitled to as it could take a huge financial burden off their lives.
Respiratory conditions can impact people in various ways, but it could make it difficult to get out and about.
The amount of PIP a person receives depends on the type of condition they have and how much the DWP thinks it impacts their ability to do things.
The DWP states that while there is no specific list of conditions that entitle people to PIP, the impact it has on one's daily life could mean they are eligible.
Become an Express Premium memberThere are a number of conditions that can qualify a person for PIP and according to Government statistics, respiratory diseases make up one of the five most commonly recorded disabling conditions that qualify for PIP.
From sleep apnoea and cystic fibrosis to severe asthma, the 24 respiratory conditions that people claim PIP for include:
Individuals can get PIP if all of the following apply:
People can make a new PIP claim by calling the DWP on 0800 917 2222.
There are also other ways to claim if one finds it difficult to use a telephone. For more information, Britons can visit the Government's website here.
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