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Challenges to Addressing Rural COPD

Rural communities face unique challenges in addressing COPD.

Tobacco Use

Greater tobacco use in rural areas contributes to the normalization of tobacco and the broad availability of tobacco products in rural communities. As a result, rural residents face greater barriers to avoiding tobacco use. In addition, secondhand smoke is another lung irritant that can cause or exacerbate COPD. Rural residents are still at risk if they live in a community where smoking is prevalent and secondhand smoke is common in the air, regardless of whether they smoke.


A greater proportion of rural residents (16.4%) live below the poverty line than urban residents (12.9%); the decline in rural poverty has been slower than that of urban poverty, widening the disparity. Limited financial resources can delay diagnosis and limit treatment options for COPD, including clinical visits and prescription medications. Additionally, patients with COPD often have multiple comorbidities and may have to choose between paying for COPD medications and/or treatments and medications for other conditions, like heart disease or diabetes.

Lack of Specialty Treatment Programs

Rural communities may lack healthcare providers who specialize in providing care to patients with COPD. For example, respiratory therapists can help to reduce hospital readmissions and transition COPD patients to the outpatient setting, but rural facilities typically have fewer respiratory therapists on staff, if any at all, compared to urban facilities. Delivery services for oxygen devices may be limited in rural areas, which can jeopardize adherence to oxygen therapy. Rural residents may need to travel long distances to visit a provider, which impacts treatment retention and effectiveness.

Lack of Transportation

Limited or nonexistent public transportation in rural areas limits the ability of rural patients with COPD to travel to and access healthcare services to manage their COPD. The disease makes breathing and physical activity challenging, which often inhibits patients' mobility and can result in their dependence on caregivers for transportation between appointments. However, conflicting caregiver responsibilities, such as work schedules, may limit their availability to transport patients with COPD to appointments and reduce the frequency of healthcare visits. In addition, severe weather in rural communities may further inhibit travel by car or bus. Not only can transportation create a barrier to accessing primary care or family medicine providers that can help manage COPD, but insufficient transportation can further inhibit a patient's ability to access specialty COPD treatments that are sparsely offered in rural communities and typically require patients to travel longer distances.

Resources to Learn More

Availability of Respiratory Care Services in Critical Access and Rural Hospitals
A policy brief providing an overview of the availability of respiratory care services in rural healthcare settings, and the implications for prevention, early diagnosis, and treatment for rural populations.
Author(s): Casey, M., Evenson, A., Moscovice, I., & Wu, Z.
Organization(s): Rural Health Research & Policy Centers
Date: 6/2018