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Pulmonary rehabilitation: assessment and outcome (this set runs into txdec08abs7)

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P41 SHOULD SMOKERS BE ALLOWED TO ATTEND PULMONARY REHABILITATION?

I Hill, AJ Williams, TJ Shaw. Royal Bournemouth Hospital, Bournemouth, UK

Pulmonary rehabilitation has an established role in the treatment of chronic lung disease reducing dyspnoea, improving both quality of life and exercise tolerance. However, although NICE guidelines state that smoking cessation is an integral part of pulmonary rehabilitation the inclusion of current smokers is a contentious issue, with many programmes precluding their attendance.

Patients and Methods: We have therefore analysed results from an established twice weekly, 7-week pulmonary rehabilitation programme comparing chronic obstructive pulmonary disease patients who are ex-smokers with current smokers. Forty-six patients were recruited, forming two study groups that were matched for age, sex, lung function and breathlessness (MRC score). All patients completed pre and post-incremental shuttle walk test (ISWT), endurance shuttle walk test (ESWT), predicted VO2 max (pVO2) quality of life questionnaire (QOL) and FEV1.

Results: The mean age was 65 years (range 55–77), 14/23 men per group; FEV1 mean 0.92 litres predicted, range 0.35–1.88 litres. Both groups showed significant post compared with pre improvements in ISWT, ESWT and predicted VO2 max. However, significant QOL scores were only seen in the current smokers group, whereas improvements in FEV1 were only seen in the non-smoking group. When comparing post-rehabilitation improvements no significant differences were seen in all measures between groups.

Analysis of Data: This study demonstrates that physical improvements made by smokers are just as great as non-smokers. Interestingly, current smokers showed a significantly greater improvement in pre to post-rehabilitation QOL than non-smokers, although this was not significant between groups. An explanation of this could be the non-stigmatic environment of pulmonary rehabilitation and the self-efficacy that they are enrolling in something positive associated with their chronic lung disease. This study provides evidence that smokers should not be excluded from pulmonary …

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