Pulmonary Rehabilitation Editorial
I am a registered respiratory therapist and respiratory care practitioner in Pennsylvania. I developed our pulmonary rehab program in 1985 and have gone through many trials and tribulations trying to keep in going, mostly because of reimbursment issues. I read your article in the July edition of RT and cannot agree with you more about the continuation of exercise post rehab. Maintainence is something insurances do not feel is appropriate, but I see it in my patients all the time. Those that have continued to be faithful to their exercise program post rehab have done very well. I also get to see those who do not continue because they are either readmitted to the hospital or are referred back to the program with much debilitation noted. I wish something could be done to help insurance realize how rehab does decrease the amount of hospitalizations. If they could only understand [that] it probably would be cheaper to pay for a year of pulmonary rehab-maintenance would be cheaper than the one hospitalization. I know a patient does not completely get away with no hospitalization, but I do know that it can be markedly reduced.

Another issue I have is with the doctors. I have found that I get to see the patient when they are at the worst physical condition as possible. I would like to see doctors referring patients to the rehab programs for education at the onset of their diagnosis. Wouldn't it be great to see the patient before they get to the point of moderate to severe lung conditions. By educating the patient early we would be preventing some pneumonias and infection that will leave damage to their lungs. I just wanted to share my feeling with you.

Constance Hess, CRT, RRT, RCP
Good Samaritan Hospital
Lebanon, Pa

July Issue of RT
Thanks for your editorial about pulmonary rehabilitation and the new guidelines. Also Patricia Carroll's article about [health] literacy is 'on target'.

I just did a presentation for our North Region CSPR meeting on inhalers and this [education]] is an identified problem area when it comes to effective use of MDIs and DPIs.

One of our biggest downfalls when it comes to adequately serving our patients is to give them an inhaler and expect them to properly use it with little or no instruction. The physician, pharmacist, nurse, and even the RCP expect the patient to read a generic sheet of "How to Use Your Inhaler" steps or the package insert.

With the exception of those few patients lucky enough to get into pulmonary rehabilitation, there is seldom an effort to learn how well the patient reads or understands those instructions.

So kudos to Patricia Carroll and to you.

Carl W. Willoughby, RRT, RCP, FAACVPR
Pulmonary Rehabilitation Coordinator
Mad River Community Hospital
Arcata, Calif