Patients with chronic obstructive pulmonary disease (COPD) face significant challenges surrounding access to care, according to research presented at the 2016 annual meeting of the American Thoracic Society.

In a report commissioned by the Lancet Respiratory Medicine, 28 leading respiratory health experts from the United States provided a comprehensive overview of current COPD care practices in the US. Data were gathered by interviewing patient representatives, healthcare providers, caregivers, insurance companies, and pharmaceutical companies to identify challenges faced by patients with COPD and to explore potential resolutions.

“This report reveals a real patchwork of care for patients with COPD,” said MeiLan K. Han, MD, MS, lead author of the commission from the University of Michigan in Ann Arbor. “The disease is the third leading cause of death in the US and disproportionately affects some of society’s most vulnerable people, yet many patients lack access to basic therapies to improve their quality of life.”

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Nearly 15 million adults (6.5% of the population) have a diagnosis of COPD; some studies have found that as many as 28.9 million people show evidence of pulmonary obstruction, suggesting that more than half of Americans with COPD remain undiagnosed.

Although access to medications, including inhalers, has improved, the commission found that many patients must provide copayments of $75 or more per drug, resulting in skipped or reduced dosages; the researchers estimate that half of medication doses for COPD are taken as prescribed. In addition, access to pulmonary rehabilitation – described by patients as one of the most helpful COPD interventions – is regularly limited due to a shortage of programs that are geographically convenient to patients and variable insurance coverage.

Research has linked more than 10 million clinician visits, 1.5 million emergency visits, and nearly 700,000 hospital stays to COPD. An overall poor standard of care and an absence of written protocols for inpatients have led to frequent hospital readmissions, although COPD remains low priority in hospital settings.

Dr Han and colleagues emphasized that prevention of initial hospital admission for COPD should be a priority, and that patient care will require overall better education for patients and clinicians. Coordinated actions between insurers and the pharmaceutical industry, as well as clinicians, will reduce the financial burden on patients with COPD, as well as increase medication adherence and reduce overall healthcare spending.

“This report aims to move us from debating what ideal care could look like, back to a discussion of what patients are actually facing on a day-to-day basis,” concluded Dr Han.


  1. Han MK. COPD care in the U.S.: A special report on behalf of the Lancet Respiratory Medicine Commission. Presented at: American Thoracic Society 2016 International Conference. May 13-May 18, 2016; San Francisco, CA.