5 Questions: Chaffee Tommarello

Welcome to Chaffee Tommarello, RRT, CPFT, AE-C, Director of the Breathing Center for Cabin Creek Health Systems, which includes the Grace Anne Dorney Pulmonary Rehabilitation Program in Dawes, WV. Her practice focuses on pulmonary rehabilitation, pulmonary function testing, respiratory disease management and black lung benefits counseling. Ms. Tommarello earned a BA in Human Resource Management from Mary Baldwin College in 2000 and a BS in Respiratory Care from Shenandoah University in 2005. She is a Certified Pulmonary Function Technologist and a Certified Asthma Educator.

What is the biggest challenge you face in improving the lives of people with COPD?

There are two:

1. It is human tendency to put off treatment while we can still function, then to feel like it is too late for treatment once we can’t function. It is a challenge to get people motivated to take care of their lung health before it becomes an even more serious issue. Then, it is a challenge to get them to believe that they can improve once their function is very limited.
2. The second challenge is related to healthcare management. We have a great system for treating sickness but a very poor system for promoting wellness. Reimbursement for preventive services is drastically lower than reimbursement for crisis-related services, medications and diagnostic testing. Pulmonary rehab should be very well reimbursed because it saves the system so much money in ER visits, admissions and readmissions. Instead, it is a challenge to sustain financially. Our own state insurance, WV Medicaid, effectively does not pay for this vital therapy. That is a travesty which limits program availability for those who need it. The system should incentivize these crucial services in respiratory disease management.

What do you think is the single most promising practice in COPD diagnosis or care right now?

The GOLD Guidelines recommend LABA or LABA+ICS as first choice therapy for Class C and D COPD patients. However, these medicines are expensive. Many of my patients have to choose between buying medicine and buying food. When they choose to buy food rather than medicine, they are susceptible to exacerbations. Patient assistance programs help, but usually only a few months a year. The potential of a more affordable LABA+ICS drug offers enormous benefit for many of my patients.

If you had a magic wand, how would you improve COPD care?

If I had a magic wand, I would eliminate tobacco use. There is no question that we would save millions of lives, including the lives of many who are now young. About 16,000 people worldwide die each day from cigarette smoking. Imagine saving those lives. Nothing else we do could have a bigger impact on the future of COPD.

What is one aspect of COPD diagnosis or care you think is too often overlooked?

Virtually every expert tells us that COPD patients should have pulmonary rehab. Yet, only about 1 in 6 COPD patients attends pulmonary rehab during their lifetime. Patients who attend pulmonary rehab have fewer symptoms, better control of their disease, and a better outlook on their life. In addition to the personal benefits, pulmonary rehab saves the system because it reduces ER visits, hospital admissions and readmissions. Every person with moderate or worse COPD should have pulmonary rehab.

What do you think will be your most important contribution to improving the lives of people with COPD?

If you want to touch the past, touch a rock. If you want to touch the present, touch a flower. If you want to touch the future, touch a life.—Unknown

I hope I touch some of my patients’ lives. More globally, I hope that I can follow Grace Anne Dorney’s vision and example in making pulmonary rehab available to more COPD patients, especially the 30% of the population who live outside large urban areas where pulmonary rehab is typically available.

This page was reviewed on March 5, 2020 by the COPD Foundation Content Review and Evaluation Committee