Cincinnati VA Pulmonary Rehabilitation Program Receives National Certification

CINCINNATI—The Cincinnati Department of Veterans Affairs (VA) Medical Center’s Pulmonary Rehabilitation Program for COPD has received certification by the American Association of Cardiovascular and Pulmonary Rehabilitation, making it the second VA program of its kind to receive this certification in the U.S.

Ralph Panos, MD, director of the program, professor in the division of pulmonary, critical care and sleep in the UC College of Medicine, and UC Health physician, says that this speaks volumes to the quality of care provided within the program at the Cincinnati VA, which has been in existence roughly three years.

"Pulmonary rehabilitation is increasingly being recognized as an essential element in the care and management of individuals with COPD and has been shown to improve quality of life, increase functional status and reduce health care utilization,” he says. "We have administrative support for the pulmonary rehabilitation program at the Cincinnati VA, and under Marci Moreno’s (pulmonary rehabilitation therapist) leadership, achieved this accreditation which truly shows the quality and cutting-edge care we are providing veterans in the Tristate area.”

COPD, or Chronic Obstructive Pulmonary Disorder, refers to chronic bronchitis and emphysema, two commonly co-existing diseases of the lungs that cause airflow limitation. The condition gets worse over time and causes difficulty breathing, coughing that produces large amounts of mucus, wheezing, chest tightness and other symptoms.

Cigarette smoking is the leading cause of COPD. It can be medically managed, but there is no cure.

"COPD is currently the fourth major cause of death in the U.S., and roughly a third of veterans in the Cincinnati metropolitan area are affected by it,” Panos says. "Pulmonary rehabilitation has been shown to greatly improve outcomes for individuals with COPD, but despite the recommendations, it is still underutilized in most hospitals throughout the country.”

The VA Pulmonary Rehabilitation Program is a 12-week, multidisciplinary program that incorporates both breathing exercises and education about the disease and treatments to help patients live a more satisfying life. 

"We educate patients about breathing during daily activities, nutrition and about ways to compensate for breathlessness, like using a chair or even using oxygen while in the shower to avoid shortness of breath,” Panos explains. "There is no way to improve lung mechanics, but we teach patients to optimize other body systems to reduce the sensation of breathlessness.”

He says that part of the program is focused on empowering the patient to avoid feelings of anxiety and depression, which can make the condition worse.

"It’s basically about feeling in control of the illness, increasing stamina and tolerating the breathlessness associated with COPD,” he says. "Anxiety can lead to hyperventilation that causes dynamic hyperinflation—air trapping—causing the lungs to hold onto air and putting respiratory muscles at a disadvantage. We try to teach correct breathing techniques, such as pursed lip breathing, to prevent or reduce air trapping.”

Panos says not everyone realizes that pulmonary rehabilitation is truly a specialized field and not something that can be done in any facility or at a local gym.

"Programs such as these have been shown to reduce hospitalizations and increase effectiveness of treatment, ultimately reducing costs,” he says, adding that the program also teaches patients how to use inhalers correctly which helps them get the most effective doses of medication. "Some patients are not taught how to use inhalers properly and get less than 10 percent of the dose. Correct use of inhalers and use of spacer devices can greatly increase the amount of medicine delivered to the lungs.”

Panos adds that this certification not only puts Cincinnati VA and UC pulmonary specialists in the spotlight, but it also draws attention to the need and benefit of pulmonary rehabilitation programs.

"Pulmonary rehabilitation is a neglected area,” he says. "We hope that this can raise awareness of the impact these programs have not only nationally, but locally as well. COPD is a huge local medical issue, and there is a significant negative stigma attached to it. While we have medicines to benefit patients, we need to focus on the holistic treatment of patients for best outcomes.”