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Respiratory conditions account for a large proportion of health care spending in the United States (US). A full characterization of spending across multiple conditions and over time has not been performed.To estimate US health care spending for 11 respiratory conditions from 1996-2016, providing detailed trends and an evaluation of factors associated with spending growth.We extracted data from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database, producing annual estimates in spending for 38 age and sex groups, 7 types of care, and 3 payer types. We performed a decomposition analysis to estimate the change in spending that is associated with changes in each of five factors (population growth, population aging, disease prevalence, service utilization, and service price and intensity).Total spending across all respiratory conditions in 2016 was $170.8 billion (95% CI $164.2-$179.2 billion), increasing by $71.7 billion (95% CI $63.2-$80.8 billion) from 1996. The respiratory conditions with the highest spending in 2016 were asthma and chronic obstructive pulmonary disease (COPD), contributing $35.5 billion (95% CI $32.4-$38.2 billion) and $34.3 billion (95% CI $31.5-$37.3 billion), respectively. Increasing service price and intensity were associated with 81.4% (95% CI 70.3-93.0%) growth from 1996 to 2016.US spending on respiratory conditions is high, particularly for chronic conditions like asthma and COPD. Our findings suggest that service price and intensity, particularly for pharmaceuticals, should be a key focus of attention for policy makers seeking to reduce health care spending growth. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Rationale: The goal of shared decision making is to match patient preferences, including evaluation of potential future outcomes, with available management options. Yet, it is unknown how patients with smoking-related thoracic diseases or their surrogates display future-oriented thinking.

In October 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) will expand its Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). Under the new policy, hospitals with high risk-adjusted, 30-day all-cause unplanned readmission rates after an index hospitalization for a COPD exacerbation will be penalized with reduced reimbursement for the treatment of Medicare beneficiaries. In this perspective, we review the history of the HRRP, including the recent addition of COPD to the policy. We critically assess the use of 30-day all-cause COPD readmissions as an accountability measure, discussing potential benefits and then highlighting the substantial drawbacks and potential unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD. We conclude by emphasizing the need to place the 30-day COPD readmission measure in the context of a reconceived model for postdischarge quality and review several frameworks that could help guide this process.