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Dr Nicola Hanania Discusses Affordability Barriers in COPD Treatment


Nicola Hanania, MD, MS, explains how some patients with chronic obstructive pulmonary disease (COPD) face challenges when it comes to affording treatment for the disease.

Nicola Hanania, MD, MS, a pulmonary critical care physician and director at the Airway Clinical Research Center, Baylor College of Medicine in Houston, Texas, highlights the importance of investing in patients' care early.


Can you give a brief overview of your work?

My name is Nicola Hanania. I'm a pulmonary critical care physician at Baylor College of Medicine. I'm the interim section chief of the pulmonary critical care section at Ben Taub Hospital in Houston and director of the Airways Clinical Research Center at Baylor College of Medicine. I'm a pulmonologist with 26 years of clinical experience. I see patients in both pulmonary and critical care. My research and clinical interests are airway diseases. I oversee an asthma/COPD clinic at Baylor. I'm involved in several clinical trials in both asthma and COPD.

Texas is one of the few states that has not expanded Medicaid under the Affordable Care Act (ACA). Given the expanded enrollment period and increased subsidies, what would it mean for patients in Texas with COPD if they had access to health coverage through either ACA enrollment or if the state did decide to expand Medicaid?

Without going into politics, which I really don't like to do, I'm a big supporter of health care for everyone. Obviously, because I work in a county hospital, I see patients who have the bare minimum and sometimes they cannot afford [treatment] although the county helps them. Some of these patients who make some income cannot afford their medications. These medications are not cheap. If we can't refer them to pulmonary rehab—an important intervention—because they don't have coverage for that, I think there is something that needs to be done, obviously, not only for COPD.

But since we're talking about COPD, many COPD patients are younger, they don't have Medicare; some of them do if they're above 65 and they are disabled, but most of them are not. Actually, you have many COPD patients who are middle-aged, who are less than 60 [years old]. They may have limited income and they cannot afford to be on good medicine. Whatever helps them to get access to care and their medication. It's not enough to go to the emergency department or clinics. It's important that they can get their medications paid for because that's not something simple.

I see that every day; we try to help out. Cost of medication is not cheap, especially these inhalers, the new devices. Again, I don't know if I answered the question indirectly but whatever needs to be done, whether it's expanding Medicaid, I think will help, especially those patients who are not as fortunate as others, who don't have private insurance. But something needs to be done for these patients because they are struggling, and we cannot prevent them from getting worse. We obviously can educate them to stop smoking. That's the most important [factor], and even that, smoking cessation strategies are not implemented widely. Some of them will cost because we would like to support these patients with some pharmacotherapies for smoking cessation, which are not cheap.

I think at all levels, we still have lots of work to do, whether it's in Texas or others. But certainly, some other states, they may have different rules and it may be easier for some patients to get their inhalers. Obviously, another big issue is the readmission issue for COPD. That's something that is not just limited to Texas. We have about 16% to 20% of patients who are readmitted within 30 days. That's another thing that puts a big burden on health care systems.

I think that if we invest in [patients’] care early, and put them on the right treatment, and advise them to quit smoking, we may actually decrease the cost overall. But we need to have our politicians buy into this concept of investing in care of these patients, putting more money up front to hopefully reduce admission and readmission. Of course, ultimately, we want to improve their quality of life and mortality.

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