Leading U.S. experts in chronic obstructive pulmonary disease (COPD) have found that patients with the condition face substantial barriers in assessing care, with hospitals failing to provide recommended standard of care, and treatment being too expensive for most patients.

This comprehensive look at COPD care in the U.S., where expert opinion from patients, caregivers, physicians, and representatives from health systems, industry, and insurance companies has been summarized, was published in a study commissioned by The Lancet Respiratory Medicine journal titled “Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective.”

“This report reveals a real patchwork of care for patients with chronic obstructive pulmonary disease. The disease is the third leading cause of death in the USA, and disproportionately affects some of society’s most vulnerable people, yet many patients lack access to basic therapies to improve their quality of life,” said Dr. MeiLan K. Han, lead author of the study and the commission from the University of Michigan in Ann Arbor, in a press release.

“As a physician, I can discuss best treatments with my patients, only to later find out it isn’t covered by their insurance, or the co-pay is simply too high. This report aims to move us from debating what ideal care could look like, back to a discussion of what patients are actually facing on a day to day basis,” Han said.

COPD is a progressive disease characterized by shortness of breath that leads to a third of deaths in the U.S. Currently, about 15 million U.S. adults have been diagnosed with COPD — 6.5 percent of the population — although it is estimated that half of the Americans with COPD are undiagnosed.

Although progress has been made in the development of diagnostics, therapies, and care guidelines, patients often face co-payments of more than $75 per inhaler, mostly because there are no generic medicines licensed for use in the U.S. Given that COPD particularly affects older adults and people from lower socio-economic backgrounds, many patients cannot afford the cost of treatments, leading them to skip days of treatment, not collect refills, or not take full recommended dosages.

COPD patients have also reported that they face challenges in accessing pulmonary rehabilitation, which has been described as the intervention that provides best results in the improvement of patients’ quality of life. Variable insurance coverage and shortage of geographically convenient programs have been limiting patients’ access to such medical intervention.

Poor standard of care during hospital stays or physician visits have also been reported by the commission, with only a third of hospitals providing patients the recommended treatments, particularly due to a lack of written protocols.

Researchers who were included on the commission claim that new research is needed in the field to better understand the disease and develop new treatments. Patients and physicians require better education to improve diagnosis and treatment of the disease, they said.

The authors also suggested that the pharmaceutical industry, insurance companies, and physicians should collaborate to lower co-pays for maintenance drugs, which will increase accessibility to treatment, and significantly improve patients’ quality of life.