Tailored Pulmonary Rehab Models Could Close COPD Treatment Gap

At the CHEST 2026 Annual Meeting in Phoenix, Omid Pourshahid, the pulmonary rehabilitation director at Temple University Hospital, made a straightforward case: the way we deliver breathing therapy to people with COPD is broken, and the fix is to stop treating all patients the same.

The numbers that frame his argument are stark. Among nearly 200,000 Medicare beneficiaries hospitalized for COPD in 2014, only about 2,700—roughly 1.5 percent—actually started pulmonary rehabilitation within three months of leaving the hospital. That gap matters because the data shows something clear: patients who did begin the program within that 90-day window had a 37 percent lower risk of dying within a year compared to those who never enrolled. The hazard ratio was 0.63, with a confidence interval tight enough to suggest the finding is real. Yet the vast majority of eligible patients never made it to a single session.

Pourshahid frames the problem in two layers. First, the infrastructure simply isn't there. Across the country, there is roughly one pulmonary rehabilitation center for every 6,030 Medicare beneficiaries with COPD. Geography determines access almost entirely. In metropolitan areas, 72.8 percent of patients live within ten miles of a center. In rural America, that figure drops to 11.3 percent. A person living in a farming community or a small town faces a fundamentally different barrier than someone in a city.

But distance is only part of it. Pourshahid grouped the reasons patients don't start or finish rehabilitation into three categories: physiologic, behavioral, and environmental. Depression and active smoking are consistent predictors of dropout. Transportation emerges as the single most stubborn barrier—not just getting to the first appointment, but sustaining the commitment week after week. A commute that eats two hours of a workday, a job with inflexible shifts, a spouse who has to leave their own work to drive someone to therapy—these are the practical facts that keep people home.

He described an approach that sounds almost obvious once stated: match each patient to the right format. Some people need center-based programs with equipment and supervision. Others could succeed with a hybrid model that combines in-person sessions with remote monitoring. Still others might engage through a fully virtual program if that's what removes the barrier. The assignment wouldn't be random. It would follow a structured assessment of a patient's clinical condition and the specific obstacles they face.

In an interview, Pourshahid reframed how pulmonologists should think about the referral itself. "I would consider it a prescription, the same way we order an inhaler when we determine the dose and the device," he said. "When I'm sending someone for pulmonary rehab, I don't just consider it a form to be filled." The distinction matters. A prescription is specific. It accounts for the person taking it. It's not a generic directive.

He also pushed back against a common hesitation: the assumption that depression or mood symptoms should delay a referral. Brief screening questions take minutes and give the rehabilitation team real information they can use to shape the sessions. Recognizing that a patient is struggling emotionally doesn't mean holding them back from therapy—it means preparing to address it.

The matched-care pathway Pourshahid proposed has not yet been tested in a prospective study, which means the field doesn't yet know whether assigning patients this way actually improves enrollment or outcomes. But the logic is sound: a treatment that saves lives only works if people actually receive it. Right now, the system is designed in a way that keeps most people out.