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Breathe Easier

Medicare offers a new benefit to people who have chronic obstructive pulmonary disease

Anita Svee quit smoking and joined an exercise class after learning she had chronic obstructive pulmonary disease (COPD), an umbrella term for lung diseases like emphysema and chronic bronchitis that impair breathing. But simple everyday tasks still left the retiree in Lomita, Calif., gasping for air and feeling panicky.

Svee, however, was fortunate. California was one of the few states to offer Medicare coverage for pulmonary rehabilitation for people living with COPD. She signed up for a 12-day program at Little Company of Mary in Torrance, which offered exercise, nutritional education, counseling and occupational therapy to improve her health and quality of life. The program, says Svee, gave her new skills for coping with COPD as well as renewed confidence.

“Now, I don’t panic if I get short of breath because I know I can control it or get out of it faster,” she says. “The class also was helpful with a lot of the things you do every day, like going up stairs or sweeping the floor. I recommend it to my friends who have COPD.”

Pulmonary rehab for COPD

Although lung experts say pulmonary rehabilitation can be helpful in reducing the effects of lung disease, lack of Medicare coverage has made it unavailable to many patients with COPD. That will change next month, when Medicare begins providing coverage for it on Jan. 1.

Scientific studies have found pulmonary rehabilitation to be an effective treatment for most patients with COPD. Yet it’s only been available to a fraction of the people who could benefit, largely because of a lack of money, says Richard Casaburi, M.D., a Los Angeles Biomedical Research Institute scientist specializing in COPD studies. Casaburi was the lead author of a recent study in the New England Journal of Medicine that found this type of therapy to be “generally superior to any other COPD therapy.”

While the details are still being worked out, Casaburi says he expects more COPD patients soon will have access to pulmonary rehabilitation when Medicare begins to provide coverage. Previously, coverage varied from one region to the next because Medicare didn’t have a national requirement.

Sen. Mike Crapo, R-Idaho, who sponsored the legislation requiring Medicare coverage of pulmonary rehabilitation, says an estimated 16 million Americans suffer from COPD. “Finding ways to assist them with treatment and services is critical, and I am pleased that we were able to incorporate this legislation” into the Medicare Improvements for Patients and Providers Act of 2008.

Undiagnosed COPD

Before the legislation’s adoption, Crapo had formed the Congressional COPD Caucus in 2004 to “educate people about the disease and its challenges.” The National Heart, Lung, and Blood Institute had launched an education program as well because it estimates that 12 million Americans likely have the disease and don’t know it.

“COPD is a killer lung disease, and it is on the rise,” says James Kiley, director of the institute’s Division of Lung Diseases. “There is an urgent public health imperative that we deal with the fourth largest killer in America.”

COPD kills more than 120,000 Americans a year—one person every four minutes—and inflicts significant and costly disabilities. It most often occurs in people age 40 and older who have a history of smoking. But as many as one out of every six people diagnosed with the disease never smoked. Environmental factors, such as dust and secondhand smoke, and a rare genetic disorder known as alpha-1 antitrypsin deficiency, also can cause COPD. A study is now under way to determine the genetic basis of the disease.

In the meantime, though, COPD patients have only medication, inhalers and pulmonary rehabilitation to help them cope with this incurable disease.

“Many of the people who have COPD have significant shortness of breath, and they become socially isolated because of their symptoms,” says Christine Garvey, a pulmonary rehabilitation therapist in San Francisco.

Because of their breathing difficulties, COPD patients often avoid physical exertion and lose muscle tone as a result. She says they’re also likely to suffer from depression and may have other health issues that interfere with physical fitness.

What rehab involves

Garvey says pulmonary rehabilitation programs seek to increase activity levels and coping skills by developing plans tailored to meet each patient’s needs. The plans include exercise under medical supervision and often with the assistance of an external oxygen supply.

As needed, patients also receive nutritional advice to lose the weight they’ve gained as a result of inactivity and psychosocial counseling to help with depression. They also receive COPD education to learn new breathing techniques and other skills for overcoming their symptoms.

In addition, patients may receive occupational therapy to help them avoid breathlessness and the panic that comes with it. In Svee’s classes, for instance, the instructors taught her a better way to climb stairs—namely by taking a breath with each stair to prevent her from overexerting herself and then gasping for breath. They also gave her a special device so she wouldn’t have to bend over to put on her shoes, suggested a new method for sweeping her house and provided other tactics for conserving her energy so she could do more.

“Pulmonary rehabilitation improves exercise tolerance, shortness of breath and the patient’s quality of life,” says Casaburi. “Without exercise, life is a downward spiral for people with COPD. Because they are short of breath, they lead sedentary lives and their muscles atrophy, making exercise and even daily activities more difficult.”

At age 80, Svee is living proof that pulmonary rehabilitation can improve lives—and that Medicare coverage makes a difference. Her home state of California was one of the few states to offer Medicare coverage before the national mandate. Without Medicare, she says, she never would have entered pulmonary rehabilitation because it was expensive, and she wasn’t certain of the benefits.

Today­—15 years after her COPD diagnosis and six years after beginning pulmonary rehabilitation—she’s still exercising three times a week. She says she no longer panics when she feels out of breath.

Instead, she relies on the tactics she learned to stay calm and overcome her breathlessness.

“I really do feel better when I exercise,” she says. “It really makes a difference.”

Laura Mecoy has written about health care issues for more than 25 years.

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