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Making Strides to Address COPD in Rural Communities

Each November, the National Heart, Lung, and Blood Institute (NHLBI) observes National COPD Awareness Month and World COPD Day. Short for chronic obstructive pulmonary disease, COPD is a serious lung disease that makes it harder to breathe and worsens over time. Of the nearly 16 million Americans who have been diagnosed with COPD, nearly 4 million live in rural areas. Compared to large cities, rural areas have higher rates of COPD, more hospital stays, and more deaths from the disease. The reasons for these disparities are complex. Higher rates of cigarette smoking in rural communities; exposure to lung irritants from farming, mining, and manufacturing; and lack of access to healthcare all play a role. More research is needed to better understand how to improve COPD outcomes in rural and other underserved communities. That is why, in November and throughout the year, NHLBI works on research and health education initiatives aimed at finding approaches that work. 

The groundwork for NHLBI’s focus on COPD in rural populations was laid in a 2018 workshop on how to apply the goals of the COPD National Action Plan to address the disease in rural areas. In the workshop, “COPD and Rural Health: A Dialogue on the National Action Plan,” rural health representatives and COPD stakeholders identified research as critical. “The 2018 workshop really set the stage for rural health as a central focus area for NHLBI-funded COPD research,” said Dr. Antonello Punturieri, program officer in the NHLBI’s Division of Lung Diseases. “Research is a key part of the unified fight to help lessen the toll of COPD on patients and families, particularly in the rural settings that are most affected.” NHLBI-supported studies are now under way to explore the causes of rural health disparities, the best ways to screen for COPD, and how to treat patients who may not have easy access to health care. 

NHLBI studies on rural COPD 

Rural areas in the U.S. south face a higher overall burden of heart, lung, and blood diseases. Yet some communities in these areas have lower rates of these diseases. NHLBI is supporting a study called Risk Underlying Rural Areas Longitudinal Cohort Study, or RURAL, to explore regional differences in rates of diseases like COPD in rural Appalachia and the Mississippi Delta. The study is looking at 10 counties in four states, evaluating the health of 4,000 participants over six years. It will try to assess the reasons behind higher disease rates and how to prevent them. 

A major NHLBI-funded study on COPD is taking place in primary care offices, including rural ones. CAPTURE: Validating a Unique COPD Screening Tool in Primary Care is studying whether a brief questionnaire and breathing test can help identify more people with COPD. Doing so could allow these patients to start treatment earlier and potentially improve their outcomes. The five-year study is looking at whether the tool is effective, useable in primary care settings, and helpful in improving the lives of people with COPD that were previously undiagnosed. The results could have important implications for COPD diagnosis in primary care settings. 

Researchers are also exploring how to make COPD treatment more accessible. Pulmonary rehabilitation (PR) is a treatment that improves quality of life for many COPD patients. Yet it is not always available in rural areas. The Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD) study is evaluating the value of video telehealth PR programs. Researchers aim to determine if a video telehealth PR intervention reduces COPD-related hospital readmissions, impacts quality of life after hospital discharge, and is cost-effective. If found to be impactful and practical, telehealth PR interventions have the potential to improve COPD patient outcomes in rural areas. 

COPD National Action Plan Community Action Tool

To track COPD research and other efforts to implement the goals of the COPD National Action Plan, NHLBI created the COPD National Action Plan Community Action Tool. The tool is a publicly accessible, online repository of activities advancing National Action Plan goals and objectives. It highlights efforts made by nonprofits, research institutions, government agencies, and others, and it helps foster collaboration between these stakeholders.

Through research and its lung health education program, Learn More Breathe Better®, NHLBI is working to improve the lives of those with COPD. To learn more about NHLBI-supported COPD research, visit For educational resources on COPD, visit