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Early inpatient-outpatient rehabilitation for COPD patients admitted with an exacerbation was feasible and safe, and was associated with a non-significant trend towards reduced acute health-care utilization.

Respiratory rehabilitation in chronic obstructive pulmonary disease: predictors of nonadherence. P. Young, M. Dewse, W. Fergusson, J. Kolbe. #ERS Journals Ltd 1999. ABSTRACT: Rehabilitation is now an integral part of chronic obstructive pulmonary disease (COPD) management. The objective of the study was to determine predictors of nonadherence to a COPD rehabilitation programme.Patients attending a COPD clinic were invited to participate in a 4 week, hospitalbased, outpatient, COPD rehabilitation programme conducted predominantly by respiratory physiotherapists. All potential participants undertook an interviewer administered questionnaire addressing social, economic, psychological and healthcare factors, and underwent baseline physiological measures. Subsequently they were classified as: 1) "adherent" group who completed the total programme (n=55) or 2) "nonadherent" group who refused or began but did not complete the programme (n=36).The nonadherent group compared to the adherent group were more likely to be divorced (22 versus 2%, p<0.005), live alone (39 versus 14%, p<0.02), and to live in rented accommodation (31 versus 6%, p<0.005). There were no differences between the two groups in terms of baseline physiological parameters (forced expiratory volume in one second, forced vital capacity, 6-min walk distance, oxygen saturation, perceived dyspnoea), quality of life domains (Chronic Respiratory Disease Questionnaire), or indices of COPD-related morbidity. The nonadherent group were more likely to be current smokers (28 versus 8%, p<0.02) and less likely to use inhaled corticosteroids (16 versus 42%, p<0.005). The nonadherent group was not significantly likely to be depressed, anxious, prone to hyperventilation or to have had previous emotional counselling and was more likely to be dissatisfied with diseasespecific social support (51 versus 2%, p<0.001).In conclusion, a substantial proportion of eligible subjects who did not participate in a chronic obstructive pulmonary disease rehabilitation programme were not more physiologically impaired, but were more likely to be: socially isolated, lack chronic obstructive pulmonary disease-related social support, still be smoking and be less compliant with other healthcare activities. Identification of one or more of these factors reliably allows prediction for nonadherence to a rehabilitation programme. Eur Respir J 1999; 13: 855±859. Rehabilitation is regarded as an integral component of a comprehensive management programme for chronic obstructive pulmonary disease (COPD) [1±3]. However, studies on adherence to COPD rehabilitation programmes are lacking. Most reports do not include details of the total population screened nor the refusal rate. However, it is clear from some prospective controlled studies that a large proportion of those screened were deemed ineligible [4,5] and that a further substantial proportion of eligible patients refused participation in the programme [4]. Adherence to therapy may be predicted by sociodemographic, psychological, physiological a...

It is unknown whether acute response to ambulatory oxygen (O 2 ) predicts longer term improvement in health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) patients.The aims of this study were 1) to assess the short-term clinical impact, as determined by HRQL, of ambulatory O 2 in a 12-week, double-blind, randomised crossover study of O 2 (versus cylinder compressed air) of dyspnoeic but not chronically hypoxic COPD patients with exertional desaturation ¡88% (n=41), and 2) to determine whether either baseline characteristics or acute response to O 2 predicts short-term (12 weeks) response. Primary outcome measures were Chronic Respiratory Questionnaire (CRQ), Hospital Anxiety and Depression scale and the short form (SF)-36.Improvements were seen in all domains of the CRQ for cylinder O 2 compared with cylinder air. Significant improvements were also noted in anxiety and depression and in certain domains of the SF-36. There were 28 (68%) acute responders to cylinder O 2 (defined as increase in 6-min walk o54 m or decrease in post-Borg dyspnoea o1) and 23 (56%) short-term responders (defined as clinically significant improvement in CRQ). However, acute and short-term responses were not correlated with no predictors of short-term response identified. At study completion, 14 (41%) of acute or short-term responders did not want to continue therapy, with 11 citing poor acceptability or tolerability.Short-term ambulatory oxygen is associated with significant improvements in healthrelated quality of life. These benefits cannot be predicted by baseline characteristics or acute response. Despite acute or short-term response, a substantial proportion of patients declined ambulatory oxygen.