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Breathe Easier

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

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— Photo by Mother Image/Getty Images

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.

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