Access to pulmonology care, which includes treatments for asthma and chronic obstructive pulmonary disease (COPD), is lacking in 488 counties across the United States. For all intents and purposes, this makes those regions “pulmonary deserts,” per a new report from GoodRx Research.

The lack of access to adequate care could disproportionately affect people with symptoms of long COVID — nearly one in five adults in the U.S., according to the Centers for Disease Control and Prevention. As many as 23 million Americans may be battling the condition.

The GoodRx researchers homed in on 8,398 locations with practicing pulmonologists, then pinpointed counties that had a majority of their population living at least an hour away from one of the physicians. They found that the country’s 15,000 pulmonologists are geographically dispersed quite unevenly, with rural counties in North Dakota, South Dakota, Montana, Nebraska and Kansas lacking immediate access to care.

To a certain extent, that reflects the reality of rural living, where access to healthcare services is more limited than in densely populated regions. But the researchers noted a drop in the number of pulmonary residency positions in recent years.

“While it may be easy to write off many of these deserts as rural counties that may not readily need access to lung care, our research suggests otherwise,” said director of GoodRx Research Tori Marsh. “Lung care treatment shouldn’t be overlooked. It’s critical that patients, especially in these deserts, access pulmonology care in order to mitigate their risk of infection or death from conditions like COPD, asthma and COVID-19.”

The report also pinpointed the counties that had the highest rates of chronic lung disease and attempted to determine whether lack of access went hand-in-hand with greater need. They found a distinct correlation.

The overlap between high rates of chronic lung diseases and lack of access to pulmonary care included vast stretches of South Dakota, Arizona, Arkansas and West Virginia. In South Dakota’s Oglala Lakota County, the rate of COPD and asthma is higher than 75% of all other U.S. counties, the report found. Still, most people need to drive an hour-and-a-half to reach a pulmonologist.

Several of the pulmonology deserts are home to Native American populations, which historically have higher rates of asthma and COPD than the general population. In Rolette County, North Dakota, 78% of the population consists of Native Americans, 30% of whom live below the poverty line. That county has a high rate of COPD, asthma and COVID-19.

“Those residents will need to choose between driving long distances to see a provider, or forgoing care altogether,” Marsh said. “This can lead to worsening symptoms of long COVID, or chronic conditions like asthma or COPD. Unfortunately, for these complex conditions, in-person care is ideal and very often telehealth is not sufficient.”

The GoodRx report arrives as researchers find an increasing incidence of long COVID around the world. But despite the rising numbers, governments have put minimal support in place to address the cases.