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Pulmonary Rehab & COPD

Stretching Exercise Pulmonary RehabFormal pulmonary rehabilitation programs have been in existence since the mid-1990s, but a rudimentary form was used to treat tuberculosis as far back as the 1880s. Over the years, diagnostic tools and intervention methods have been refined and the therapy has expanded its use to a wide range of respiratory conditions from chronic obstructive pulmonary disease (COPD) to cystic fibrosis (CF) and many others in between.

For the most part, traditional pulmonary rehab programs serve the same patient population and follow a similar treatment protocol. Richard Novitch, MD, pulmonary rehabilitation director and director of the pulmonary function laboratory and blood gas laboratory at Burke Rehabilitation Hospital in White Plains, New York, explained that the treatment is directed toward patients suffering from a reduction in quality of life due to COPD or other lung diseases. "It's a way to help people develop coping strategies with the limitations of life activities," he said. "Regardless of age and underlying diagnosis, the quality of life issues are the same."

Shortness of breath often prompts a referral from a pulmonologist, internist, or primary care physician. Patients sometimes ask to self-enroll; however, in order to comply with Medicare guidelines, which drive pulmonary rehab protocols, the patient must have a physician referral.

Medicare Part B may cover the cost of pulmonary rehab if certain conditions are met. The patient must have a diagnosis of moderate to very severe COPD (validated by pulmonary function tests), and must be documented to meet Medicare's GOLD Classification II, III, or IV. Medicare also requires all pulmonary rehab programs to include physician-prescribed exercise, education, and training customized to each patient, along with psychosocial and outcome assessments. Moreover, the exercise plan must designate mode, target intensity, duration of each session, and frequency.

The physician must review the treatment plan every 30 days. A total of 36 visits are allowed with an additional 36 upon receipt of a letter recommending more rehabilitation. Other insurers may cover pulmonary rehab, and many often follow Medicare's protocol requirements.

Risks in pulmonary rehab programs are virtually nonexistent, said Novitch. "Patients exercise to tolerance of risk. The lungs act as governor on an engine. If the patients are sick, they don't show up. Also, Medicare guidelines require a doctor to be within walking distance- 300 feet- of a program," Novitch noted, adding that other clinical professionals are in attendance at all times.

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Hanlon, Phyllis. (2013, October 14). Pulmonary Rehab: Expanding Its Clinical Impact. [Web log post]. Retrieved November 21, 2013, from http://www.rtmagazine.com/clinical/19206-pulmonary-rehab-expanding-its-clinical-impact.

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