This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.
Individuals who live in rural areas have significantly higher rates of COPD and COPD-related hospitalizations and deaths than those who live in urban areas. In fact, those who experience COPD and reside in rural counties (8.2%) are almost double the number of those individuals who live in urban areas (4.7%). States with higher quartiles for COPD are Alabama, Arkansas, Indiana, Kentucky, Mississippi, Tennessee, and West Virginia, four of which have higher percentages of rural residents (Croft et al., 2015). These rural individuals are more likely to experience negative social determinants of health, such as lower incomes, education, chronic illness and comorbidities, and disability, with more individuals commonly foregoing medical care due to having inadequate health insurance and monies (Gaffney et al., 2022).
Several rural COPD investigations are underway, including one 6-year study of4,000 individuals examining regional differences in disease rates of COPD and other diseases in rural Appalachia and the Mississippi Delta. Another 5-year study is determining whether a short questionnaire and breathing test can help identify more people with COPD in primary care settings, potentially improving their quality of life and outcomes. Yet another investigation is exploring whether video telehealth pulmonary rehabilitation lessens COPD-related hospital readmissions and improves quality of life. Some rural counties already have used pulmonary rehabilitation programs to improve health outcomes and quality of life of these individuals (Doyle et al., 2017).
A recent systematic review of six telehealth and five non-telehealth self- management interventions delivered to rural adults with COPD, was promising in showing how telehealth interventions could be as useful as non-telehealth interventions for improving COPD self-management (Stellefson et al., 2022). Another systematic review and meta-analysis of 19 studies comparing the effect of minimal equipment and exercise equipment-based programs on exercise capacity, health-related quality of life, and strength in pulmonary rehabilitation. There was no difference between the two programs for either exercise or strength, but better health-related quality of life was seen when using minimal equipment. These findings suggest pulmonary rehabilitation programs using minimal equipment may be a suitable intervention where access to gymnasium equipment is limited, as in rural areas (Cheng et al., 2023). Some of these studies and others can be identified by using the COPD National Action Plan Community Action Tool., a public, online categorical list of activities for key stakeholders such as rural nurses who desire to implement useful interventions to improve the quality of care they provide for individuals living with COPD (NHLBI, 2021; 2023).
References
Cheng, S. W. M., McKeough, Z. J., McNamara, R. J., & Alison, J. A. (2023). Pulmonary rehabilitation using minimal equipment for people with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Physical therapy, 103(5), pzad013. https://doiorg.uab.idm.oclc.org/10.1093/ptj/pzad013
Croft, J. B., Wheaton, A. G., Liu, Y., et al. (2018). Urban-rural county and state differences in chronic obstructive pulmonary disease — United States, 2015. MMWR: Morbidity & Mortality Weekly Report, 67, 205 211. http://dx.doi.org/10.15585/mmwr.mm6707a1
Doyle, D., Tommarello, C., Broce, M., Emmett, M., & Pollard, C. (2017). Implementation and outcomes of a community-based pulmonary rehabilitation program in rural appalachia. Journal of Cardiopulmonary Rehabilitation and Prevention, 37(4), 295–298. https://doi.org/10.1097/HCR.0000000000000247
Gaffney, A. W., Hawks, L., White, A. C., Woolhandler, S., Himmelstein, D., Christiani, D. C., & McCormick, D. (2022). Health care disparities across the urban-rural divide: A national study of individuals with COPD. The Journal of Rural Health, 38(1), 207–216. https://doi.org/10.1111/jrh.12525
NIH: National Heart, Lung, and Blood Institute. (2021, February). COPD National Action Plan: Community Action Tool. https://cnap.nhlbi.nih.gov/index.php/
NIH: National Heart, Lung, and Blood Institute. (2023, November 15). Making strides to address COPD in rural communities. https://www.nhlbi.nih.gov/news/2023/making strides-address-copd-rural-communities
Stellefson, M., Kinder, C., Boyd, I., Elijah, O., Naher, S., & McFadden, N. (2022). COPD self-management for adults living in rural areas: Systematic review of telehealth and non-telehealth interventions. American Journal of Health Education, 53(5), 269–281. https://doi.org/10.1080/19325037.2022.2100525
