Patients with lung disease often have complex comorbidities. As the number of elderly in America and worldwide grows, we can expect many older individuals presenting for pulmonary rehabilitation (PR) with multiple comorbidities. During this session we will review the epidemiologic changes seen in the PR population and highlight the comorbidities associated with chronic lung diseases. We will highlight the potential impact of these comorbidities on patient and program outcomes and put forward beneficial treatment strategies. Patients engaged in lung transplantation programs have further unique challenges and needs. As the field of transplant medicine evolves and in the context of an increasing availability of organs, many more PR programs will be managing this complex population both pre- and post-transplantation. We will discuss the development of a comprehensive pulmonary rehab program for lung transplant patients providing a blue-print for implementation. From conception of the program to delivery of care across all sites, we will address: program design and staffing needs; engagement with the Transplant Team and writing of the protocol and procedure manuals; patient referral, engagement and retention; special needs of the lung transplant population; patient evaluation and outcomes; management of volume growth – defining and refining the business model. Attention to detail allows PR programs for lung transplant patients to develop, thrive and add to the value a health care system provides its patients. Value based management will be addressed focusing on the impact of PR across the continuum on reduction in length of acute care stay, readmission reduction, and patient satisfaction and outcomes. Common functional comorbidities associated with this patient population and prevalent medical complications seen along the continuum of care will be discussed empowering the rehabilitation professional to identify complications early.