Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD

Objective: To investigate the modulating effects of current smoking on adherence and responses to pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Methods: In a prospective study, 18 ex-smokers and 23 current smokers (GOLD stages II-III) were enrolled in a 12-week multidisciplinary, supervised PR program. The patients were assessed clinically and as to subjective variables (dyspnea and health-related quality of life) and objective variables (body composition, pulmonary function and 6-min walking distance). The degree of nicotine dependence in current smokers was assessed by the Fagerstrom test. Program completion defined PR adherence. Results: There was a significant association between current smoking and non-adherence to PR with 30.4% vs. 11.1% and odds ratio=2.9 (1.6-4.1; p<0.01). However, the current smokers who completed the program (n=16) had a similar absentee rate to the ex-smokers, as well as similar gains in the subjective (quality of life) and objective (walked distance) items. Additionally, there was a significant reduction in daily cigarette consumption and in the degree of nicotine dependence in current smokers (p<0.05). Conclusions: Although current smoking is negatively related to PR adherence, CORD smokers who complete the PR can have similar gains in functionality and quality of life compared to ex-smokers. Moreover, PR may be related to decreased nicotine dependence, even without a formal smoking withdrawal program.