Exercise to Improve Patients Lives With Pulmonary Rehabilitation

Only a year ago, Florence Attaway for decades a half pack a day smoker struggled to walk even one city block. “I had to take a taxi from my home one block to the hospital because I could hardly breathe,” said the 83-year-old New Yorker, who has chronic obstructive pulmonary disease (COPD) and asthma. But since coming to the Pulmonary Wellness & Rehabilitation Center in midtown Manhattan where she does treadmill and bicycle exercise for an hour every Tuesday and Thursday Attaway has far more stamina.

“Now I can walk two blocks and even do housework,” she said. “If it weren’t for Dr. Greenspan, I wouldn’t be here.” Like Attaway, Nancy Schlick of Brooklyn Heights is also 83, and also has COPD. “They start smoking when I was 16,” said Schlick. “But the minute I got my diagnosis, I said I’d never smoke another cigarette. Then my husband died of lung cancer. They was destroy. They went back to cigarettes just to feel better.”

Cardiopulmonary exercise sessions

Both women are patients of physical therapist Noah Greenspan; whose 10th floor practice at Fifth Avenue and East 38th Street specializes in pulmonary fibrosis (PF) and pulmonary hypertension (PH) as well as COPD; though its services are open to anyone with acute or chronic respiratory disease. About 250 patients visit the clinic regularly; most of them coming twice a week. He also has tens of thousands of followers online. Since its inception, the center has conducted more than 100,000 cardiopulmonary exercise sessions.

Greenspan hates cigarettes but admits to having smoked a total of two packs that lasted him through four years of high school. “They think cigarettes should be illegal. They kill you,” he said. “Occasionally, I have patients who are still smokers. Some programs won’t allow you in if you smoke; but they don’t agree with that, because people already feel bad enough.” While 80% of COPD patients are smokers or former smokers, tobacco use is not a known contributor to either PF or PH. Particularly difficult is idiopathic pulmonary fibrosis (IPF), a disease of exclusion.

“Essentially, these patients were being exclude from the programs because they were too sick. They were super-short of breath, desaturated with minimal exertion, and need a ton of oxygen. They were basically being told to go home and die,” he said. “My mentor, Horacio Pineda, MD, and they figure if that’s their only option; then they really don’t have that much to lose by trying rehab. So they start giving people as much oxygen as they need.”

Pulmonary Rehabilitation

Fewer than one tenth of 1% of physical therapists specialize in cardiovascular; also pulmonary physical therapy, according to Greenspan. “There’s a complete lack of access to pulmonary rehab in New York City. They’ve gone from five programs to three in a city of eight million people,” he said; lamenting the recent closure of pulmonary programs at Beth Israel Medical Center and St. Luke’s Roosevelt Hospital. That left his own clinic along with NYU and Columbia University as the only ones offering pulmonary rehabilitation in all of New York.

Medicare pays $120 per visit, said Greenspan. The problem is that it costs about $1 million a year to run this clinic. “They think every hospital should have their own pulmonary rehab program, especially because Medicare penalizes you if your patient gets readmitted,” he said. “The problem is increasing.” Physical therapist Marion Mackles has worked at Greenspan’s clinic from the very beginning.

But it’s more than that, said Mackles, a dancer who also writes poetry and gives massages in her spare time. “They also know this may be the only time they can socialize,” she said. “Many of our patients are either alone, or they’re with people who just don’t understand their disease, and the things they can and cannot do. So when they come here, we try to make this place non-clinical. Everything is light and fun. We joke around. We wear bright colors. It’s all part of trying to make people feel good and normal.”