Arguing the pro side of a debate at the American College of Chest Physicians (CHEST) 2026 Annual Meeting in Phoenix, Omid Pourshahid, MD, MPH, FCCP, Medical Director, Pulmonary Rehabilitation, Temple University Hospital, said pulmonary rehabilitation should be tailored to each patient’s clinical status and barriers to care rather than delivered through a single center-based model.¹
The position builds on a long-standing gap in pulmonary rehabilitation uptake. In a retrospective cohort of 197,376 Medicare beneficiaries hospitalized for COPD in 2014, only 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge.² Initiation within the 90-day window was associated with a lower risk of death at 1 year (hazard ratio [HR], 0.63; 95% CI, 0.57-0.69; P <.001).
“For pulmonologists referring patients for pulmonary rehab, I would consider it a prescription, the same way we order an inhaler when we determine the dose and the device,” said Pourshahid, director of pulmonary rehabilitation at Temple University Hospital, in an interview with HCPLive. “When I’m sending someone for pulmonary rehab, I don’t just consider it a form to be filled.”
Pourshahid said each referral should address 2 questions: whether the patient can safely start in a home-based or telerehabilitation program, and which barrier is most likely to keep the patient from attending.
Barriers to Pulmonary Rehabilitation Uptake in COPD
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
