Respiratory Care: Three Experts Talk Disease Management

The cost of ineffective chronic respiratory care affects patients across the spectrum of needs. Access to medication, effective treatments, identifying high-risk patients, and continuing education are at risk without a proactive approach.

Chronic respiratory conditions like asthma and COPD are among the most expensive and preventable drivers of healthcare spending. Where are we still falling short when it comes to managing these conditions proactively, and what’s the cost of continued inaction?

Despite what we know about asthma and COPD, we still have a long way to go to achieve consistency in proactive care, rather than reactive care. Care often begins after symptoms escalate, when patients present to the emergency department or require hospitalization.

We also continue to underestimate the ways in which medication access, cost, and variability undermine even the best clinical plans. Up to 25% of people nationwide with chronic lung disease are unable to fill their prescribed medications due to costs. Many patients are prescribed evidence-based therapies they cannot afford, cannot consistently obtain, or are frequently forced to change because of formulary and insurance coverage shifts. This can result in poor adherence, confusion, and preventable exacerbations.

The cost of this approach is high and includes avoidable hospitalizations, emergency visits, lost productivity, and billions in unnecessary healthcare spending. According to the American Lung Association data, more than $25 billion is spent each year on COPD medical costs, with $12 billion of that going to prescription medications.  

More importantly, we must consider the cost of patients living with a reduced quality of life due to unstable illness. We know better outcomes are well within reach.

What does a proactive approach to chronic respiratory disease management look like in practice, and what are the biggest barriers preventing us from getting there?

A proactive approach starts with recognizing chronic respiratory disease as something we manage continuously, not episodically. In practice, that means consistent monitoring, early intervention, evidence-based protocols, strong transitions of care, and full use of the respiratory therapist’s expertise in all areas of care. It also means meeting patients where they are with education, support, and practical tools they can use every day.

Medication cost has long been a barrier to effective symptom management. For this reason, some states have taken action to protect against high costs. Illinois, for example, has capped a 30-day supply of inhalers to a max of $25 out of pocket. The law also exempts prescription inhalers from deductibles, recognizing their role as essential and maintenance therapies. This policy is particularly impactful for patients who require multiple inhalers and who previously faced monthly costs that could reach hundreds of dollars per medication.

Illinois is not alone in this effort. Other states, including Minnesota, Washington, New Mexico, New Jersey, and others, have enacted or passed similar legislation to cap inhaler copays, signaling growing recognition that medication affordability is central to effective chronic respiratory care. 

Many high-risk patients go unidentified until they’re already in crisis. What’s been effective for engaging these individuals earlier in their care journey?

Using existing data to identify patients with frequent exacerbations, medication fill patterns that suggest poor symptom control, or repeated emergency department visits allows care teams to intervene earlier. Integrating pulmonary function testing for high-risk patients into primary care and specialty clinics also helps identify individuals who may have undiagnosed or progressing COPD.

Respiratory therapists play a critical role when they are involved before hospitalization. Early education, inhaler technique assessment, and reinforcement of individualized action plans improve patient understanding and daily symptom management. Engagement is strongest when care is consistent, and relationships are built over time. When patients recognize early signs of worsening symptoms and know who to contact before those symptoms escalate, we see fewer emergency room visits and more planned, supportive care.

How do you see the future of proactive respiratory care taking shape?

The future of proactive respiratory care is integrated, data informed, and team based. I envision respiratory therapists embedded within chronic disease management teams, using data, remote monitoring, and digital tools to identify risk early and support patients beyond the hospital. 

Working in close partnership with physicians, nurses, pharmacists, and care managers, respiratory therapists can help patients remain stable, maintain lung function, and stay at home whenever possible.

Aligning policy and payment with these outcomes will be essential so prevention becomes an expected part of care. By committing to this approach, we can move from reacting to respiratory disease in crisis to supporting lung health consistently throughout a lifetime.

Chronic respiratory conditions like asthma and COPD are among the most expensive and preventable drivers of healthcare spending. Where are we still falling short when it comes to managing these conditions proactively, and what’s the cost of continued inaction?

Twenty-eight million people (one in 12) in the United States have asthma. Asthma is a leading cause of missed days of work and school and the most common chronic condition in children. The estimated annual cost of asthma — including healthcare costs and lost productivity — is more than $115 billion a year. And, between nine and 11 people die from asthma each day. 

The high cost of medicine is cited by our community as the top reason people with asthma can’t access the treatment they need. Improving access to treatment means fewer emergency department visits, hospitalizations, and deaths due to asthma. 

What does a proactive approach to chronic respiratory disease management look like in practice, and what are the biggest barriers preventing us from getting there?

Access to treatment and to education and resources for managing asthma makes a difference. The Center for Disease Control’s (CDC) National Asthma Control Program (NACP) funds asthma management programs in 29 states. NACP-funded programs increase reports of well-controlled asthma while decreasing missed days of work and school and hospitalizations due to asthma. 

We know what works: clear, focused education and access to effective treatments. 

There are barriers related to cost and access; we can overcome those by continuing to raise awareness and by ensuring policymakers hear the voice of our community.

Many high-risk patients go unidentified until they’re already in crisis. What’s been effective for engaging these individuals earlier in their care journey?

The Allergy Foundation of America’s (AAFA) Health Equity Advancement and Leadership (HEAL) program supports local programs using community health workers (CHWs) to conduct targeted interventions. HEAL provides measurable health equity benefits, improving asthma control, restoring productivity, and helping more people with asthma live healthier, fuller lives. This program shows that providing education and resources leads to better asthma management and improved quality of life. 

How do you see the future of proactive respiratory care taking shape?

Proactive respiratory care looks like improved access to essential medicines. This means changes that reduce cost and increase access. It also means funding programs that provide asthma management resources and education. The future of proactive respiratory care is a combination of policy change and focused intervention. A key to all of that is raising awareness of both the impact of asthma on health and quality of life and what it looks like when asthma is well-controlled. When we begin to understand the success of programs like NACP and HEAL, we can expand their impact and save and improve lives. 

Chronic respiratory conditions like asthma and COPD are among the most expensive and preventable drivers of healthcare spend. Where are we still falling short when it comes to managing these conditions proactively, and what’s the cost of continued inaction?

I’ve had asthma my entire life. I’ve had near-death experiences because of it. So when I look at where we’re falling short, it’s not academic for me. It’s personal.

The core problem is that we’ve built a reactive system around conditions that are, by their nature, manageable with the right information at the right time. People with asthma and COPD are largely left to self-report symptoms they’ve often normalized, see a clinician periodically, and hope that the medication they were prescribed still fits their current reality. It doesn’t work. And the data reflects that.

Hospitalizations, prescriptions, office visits, and emergency room care for asthma and COPD can exceed $46,000 per person per year. That’s not a rounding error. That’s a system paying for crises it had every opportunity to prevent. The economic burden of COPD alone runs into tens of billions annually in direct medical costs, and that doesn’t account for lost productivity, caregiver burden, or the profound impact on quality of life.

What we’re still missing is continuity. There’s too much space between when something starts to go wrong and when anyone with the ability to intervene first finds out. We don’t have scalable ways to continuously understand what’s happening between visits, as people live, work, and  play with these conditions, gauging how much they know and understanding how to reach out to them so they can internalize. That gap is where the damage happens, and it’s where the cost accumulates. Continued inaction doesn’t just mean more expensive care, it means more people suffering unnecessarily, and more families living without peace of mind. As I always say, when you can’t breathe, nothing else matters. 

What does a proactive approach to chronic respiratory disease management look like in practice, and what are the biggest barriers preventing us from getting there?

Proactive management means knowing what’s happening in someone’s lungs before they’re in distress, and having a trusted relationship in place so that information can be actioned quickly. In practice, that requires three things working together: 1) continuous monitoring that captures real data from daily life, more than just a snapshot in a clinical setting; 2) access to a respiratory care expert who knows that person and their history; and 3) behavioral support to help them build and sustain habits that actually work for them.

An integrated care approach that encourages self-management and self-actualization is necessary to identify exacerbation triggers and onset, and ultimately optimize clinical outcomes, reduce costs, and improve quality of life. That’s not a novel idea: It’s what we’ve learned works for other chronic conditions like diabetes. The question is why we haven’t applied it consistently to respiratory disease?

The barriers are real. The first is awareness. Many people with asthma or COPD don’t fully understand the severity of their own condition. They’ve adapted to a diminished baseline and don’t know what “better” feels like. The second is engagement. Asking someone to log symptoms manually, fill out forms, and stay motivated without feedback is a failing model. The third, frankly, is structural: healthcare workflows were built around episodic reimbursement models, fragmented data systems, and reactive intervention. Clinicians are also overwhelmed. We cannot solve chronic disease management simply by asking already-burdened healthcare teams to work harder.

That’s why scalable proactive must combine continuous insight, intelligent prioritization, and human clinical support. Importantly, technology alone is not enough. Engagement and trust matter enormously in respiratory disease management. Patients do best when they feel supported, understood, and empowered — not monitored.

Many high-risk patients go unidentified until they’re already in crisis. What’s been effective for engaging these individuals earlier in their care journey?

One of the biggest lessons we’ve learned is that engagement improves when care becomes more responsive, personalized, and human.

High-risk patients are often labeled “noncompliant” or “hard to engage,” but many are actually navigating genuine lack of insight into what’s going on. We’ve yet to meet someone who doesn’t want to do better. After all, when you can’t breathe, nothing else matters. But patients who are already dealing with the stressors of life — transportation barriers, caregiver burden, financial stress, anxiety (a side effect of meds and these conditions) — may have had years of frustration with inconsistent care. 

So engagement has to start with meeting people where they are. That’s perhaps an over-used term, but it’s more about the psychological construct of understanding the patient rather than just community-based interactions.

What’s been effective is home-based support, continuous but low-friction engagement, culturally aware care teams, and helping patients understand what their bodies are telling them in real time. You don’t start with the hardest thing. You start by building trust and demonstrating value in small, meaningful ways.

Yes, we provide a unique wearable, and that’s an important part of the equation, but not for the reason people might assume. It’s not about technology. It’s about giving people objective data about their own body that they’ve never had access to before. One of our members described it this way: Even though she thought she was well-controlled, she often didn’t understand her symptoms, because she’d become so accustomed to them. Having a way to see her personal baseline and know when she was drifting from it changed how she engaged with her own care entirely. That kind of insight is what creates the motivation to act earlier.

How do you see the future of proactive respiratory care taking shape?

I think we’re moving toward a future where respiratory care becomes far more continuous, personalized, and predictive. Today, most systems still react after deterioration occurs. In the future, we’ll increasingly identify subtle physiologic changes earlier and intervene before exacerbations become crises. That shift has the potential to fundamentally change both outcomes and healthcare economics.

I also believe care will continue moving beyond the walls of the clinic. The home is where respiratory disease actually happens, and future models will increasingly support patients there through combinations of connected sensing, intelligent software, personalized education, and clinician-guided care

At the same time, we need to be thoughtful about preserving the human side of healthcare. Technology should augment human care, not replace it. The most effective future systems will combine continuous insight, intelligent prioritization, and compassionate clinical support. 

What’s going to accelerate this is validation. The HCO Virtual Respiratory Care Program is the first respiratory-focused digital health solution (and first wearable) to be independently validated by the Validation Institute. That kind of rigorous, outcomes-based evidence is what moves payers, employers, and health systems from curiosity to commitment. When you can show that meaningful improvement in outcomes leads to real cost reduction and then back that promise with accountability, the conversation changes

Ultimately, proactive respiratory care should help people spend less time navigating disease and more time living their lives.