Christopher Mosher, MD, MHS: Future of Respiratory Care Following Updated Guidelines for Pulmonary Rehabilitation

In another interview segment, Christopher Mosher, MD, MHS, spoke with HCPLive about key barriers to widespread adoption of pulmonary rehabilitation (PR) as well as the future of respiratory care and of respiratory disease management.

Mosher works as a clinical researcher and pulmonologist for Duke University, in addition to working as assistant professor for Duke Health.

The study which produced the new guidelines Mosher referenced here had been conducted to enhance the clinical application of PR as well as to provide direction for global health policy. He was asked to compare supervised maintenance PR versus usual care following initial PR for adults with COPD.

“I think it's important when we think about this recommendation, and the result is that there was a lot of heterogeneity amongst the studies that were included in maintenance,” Mosher explained. “This could include exercise, exercising once or twice a week, or could be as variable as just once a month. Given the kind of lack of overall evidence in this field, and the heterogeneity among the results, the committee was unable to recommend in a strong fashion that maintenance right now should be strongly recommended. And it's a conditional recommendation.”

Mosher further explained that all patients, whether they have COPD or not, and particularly those who are older adults, are encouraged to exercise 150 minutes a week at a moderate intensity.

Despite the apparent benefits of PR, it is known to be underused. Mosher was asked about the barriers to the widespread adoption of PR, and how the new guidelines could contribute to overcoming them.

“This has been reflected in the literature that the most common barriers I see with my patients are, cost of their copayments, transportation, or caregiver responsibilities, precluding them,” he said. “I think, again, this is an area where telerehabilitation can really assist in this unmet need. To me, and I think many others, it's not an either or statement. I think we want to see a path forward where both center-based rehab continues to be incentivized and motivated but also there's a parallel path to develop and refer patients to comprehensive, highly structured and well validated virtual telerehabilitation options.”

Mosher was also asked how he anticipated the latest guidelines shaping the future of respiratory care as well as the management of chronic respiratory disease.

“I think these guidelines, they they're very straightforward. And I liked that they were so direct, and that in order to tackle such a big problem, it's going to not take just healthcare providers, not patients advocating, and not even the addition of entrepreneurship and businesses, like I alluded to, but really, we need to work hand in hand, all those communities need to work hand in hand with health policy care makers.”

For further information on Mosher’s main points, view the full interview segment above.

In this article, the quotes from the interview were edited for clarity.