Pulmonary rehabilitation has been demonstrated to improve outcomes in patients with chronic obstructive pulmonary disease (COPD), but financial- and access-related barriers can prevent patients from receiving this essential care. The American Thoracic Society International Conference 2026 (ATS 2026) included a discussion on a novel model that may help address these challenges.

Following this presentation, featured expert Nicola A. Hanania, MD, MS, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Hanania on these findings are presented here.

Carolyn L. Rochester, MD, from Yale University School of Medicine, gave an update at ATS 2026 on the current state of pulmonary rehabilitation. Her presentation summarized where we are currently, where we are going, and what unmet needs remain in pulmonary rehabilitation.

The definition of pulmonary rehabilitation has undergone changes, and the 2023 guideline from the ATS now defines it as “a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies. . . .” It includes, but is not limited to, exercise training, education, and behavioral change. The purpose of pulmonary rehabilitation is to improve physical and psychological conditions for people with COPD and to promote long-term adherence to health-enhancing behavior.

Even though the lungs are the main focus of our attention as pulmonologists, because COPD is a chronic lung disease, many of these patients eventually experience disabling exercise intolerance. This can affect quality of life, cause deconditioning, and lead to disease worsening, and it may also increase the risk of exacerbation and disease progression. It is a vicious cycle, and many studies have shown that muscle dysfunction in patients with COPD has been associated with poor outcomes. There are several types of exercise training for pulmonary rehabilitation, including endurance training, strength training, and a combination of the two. However, even though exercise has been well noted to improve outcomes in individuals with COPD, many patients are either not referred for pulmonary rehabilitation or experience financial and/or access barriers. This is a major unmet need in the United States and around the world.

So, again, the essential components of pulmonary rehabilitation include exercise training, patient education, psychosocial assessment, outcome measures, and quality assurance. Pulmonary rehabilitation is really a combined effort in a multidisciplinary program. Usually, it is prescribed for at least 2 to 3 visits per week and lasts for 8 to 12 weeks, followed by maintenance.

The benefits of pulmonary rehabilitation have been published in multiple papers, and they include improvements in exercise capacity, quality of life, and the ability to complete daily activities, as well as reductions in dyspnea, fatigue, anxiety, depression, hospitalization, and exacerbation. A large retrospective study suggested that it may actually reduce mortality, although this has not been confirmed. Currently, the best resource for information on pulmonary rehabilitation is the previously mentioned ATS guideline, which clearly answers several questions regarding the improvement of many outcomes in patients who undergo pulmonary rehabilitation.

Some novel aspects of pulmonary rehabilitation were discussed during Dr Rochester’s presentation at ATS 2026. One is the use of telehealth for home-based pulmonary rehabilitation right after an exacerbation. Access to pulmonary rehabilitation may be costly, and patients may not be able to attend 3 sessions per week due to driving distance or other barriers. Dr Rochester made the very important point that access to pulmonary rehabilitation in the United States—especially among veterans—is very poor. This remains a significant issue for our country to tackle. To address this, several centers are now administering telerehabilitation through video conference. However, questions remain regarding how this novel model compares with traditional in-person pulmonary rehabilitation, and I think that more studies are needed. Although center-based pulmonary rehabilitation programs remain the best choice, reimbursement issues and barriers to patient access are realities that we need to address.