What is wrong with the people with COPD who fail to attend pulmonary rehabilitation ? - A report of the CoHoRT study of pulmonary rehabilitation.

JC Waterhouse F Begg  RA Lawson

Sheffield Teaching Hospitals NHS Trust

In a recent UK Health Technology Assessment Board funded study we had dropouts between randomisation and pre rehab assessment, and people who were assessed and failed to attend, or only attended less than 50% of sessions.  This reflects general experience within pulmonary rehabilitation.

Patients had COPD and MRC grade 3 or worse dyspnoea. n =161 (m:f 88:73) Age = 69 (±7.8) FEV1 47% Predicted (±18)    We have examined demographics, including socio economic data, shuttle walking test distances, spirometry and disease specific and generic health related quality of life (HRQoL) results to discover pointers towards who in unlikely to attend pulmonary rehabilitation.

We have little information regarding those who fail to attend for assessment.  There is a tendency for the non/poor attenders to be lower in BODE index (ref), and to be widowed.  Generic HRQoL measurement shows significant differences between "poor" and "good" attenders especially in social functioning and mental health.

Mental health is the variable that is possibly open to change.  We propose that targeted psychological or pharmacological therapy may increase uptake or reduce dropout.

The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease.  Celli, et al  NEJM 10: (350) 1005-1012

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