For many years, respiratory care professionals have excluded COPD patients who are current smokers from admission to pulmonary rehabilitation programs. The basis of this exclusion has been a belief that smokers will not stick with the rehab program due to a lack of desire to make positive changes in their lives. Additionally, respiratory care professionals believe that smoking dilutes the benefits gained in pulmonary rehab. Well, a new study published this month demonstrates that while both of these assumptions may be true – current smokers still significantly benefit from completing a traditional pulmonary rehab program.
The study, conducted by a research team in Brazil, included 41 moderate to severe COPD patients (18 former smokers and 23 current smokers). Both groups participated in a traditional pulmonary rehab program 3 days/week for 1 hour each session for a total of 3 months. In those sessions, both groups participated in observed cardiovascular and strength training exercise, and received counseling on topics such as breathing techniques and nutrition. Though the dangers of smoking were discussed with both groups, there was no formal smoking cessation program as part of the rehab program. (Santana VT, et al. Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD. Rev Bras Fisioter. 2010 Feb; 14(1):16-23)
The results were eye opening. While more current smokers dropped out of the rehab program (7 of the 23 dropped out) during the study than former smokers (2 of 18 dropped out), the current smokers who completed the program experienced significant gains in physical conditioning and self-reported quality of life, and in most cases achieved gains similar to the former smokers.
More important, of the current smokers who completed the program, 19% stopped smoking by the end of the program, and over 50% of the remaining current smokers saw moderate drops in their nicotine dependence.
We’ve long argued that it is a mistake to exclude current smokers from pulmonary rehab. In doing so, we’ve argued that pulmonary rehab is a potentially powerful weapon to improve the health status of smokers whether they quit or not. We’ve also suggested that participating in an ongoing exercise program might improve smoking cessation success rates. This study’s results seem to support both positions (there have been a few other studies over the past couple of years with similar findings that have not garnered much attention).
As the Brazilian research team concluded, “The results of this study indicate that, although current smoking was negatively related to adherence to PR (pulmonary rehabilitation), the clinical and physiological gains were generally similar in ex-smokers and current smokers. In addition, the PR was associated with a significant reduction in nicotine dependence in current smokers. These results indicate that although a higher rate of withdrawal from PR can be antici¬pated in smokers with COPD, there seems to be no a priori clinical or physiological grounds to exclude such patients from PR programs.”
While this study’s findings are significant, it is unlikely to result in a broadening of access to pulmonary rehab programs for current smokers in the near term for two reasons. First, physicians will want to see studies involving larger COPD patient populations that confirm these results. Second, access to pulmonary rehab is still very limited and respiratory care professionals will likely opt to admit only those patients who have a high probability of completing the program and they continue to view current smokers as less likely to complete a full course of pulmonary rehab.
Still, if you have been diagnosed with COPD (stage II or stage III) and you are a current smoker, we recommend you ask your doctor for a referral to a pulmonary rehab program in your area anyway - even if you aren’t ready to stop smoking. If your doctor won’t make the referral until you complete a smoking cessation program or the pulmonary rehab program won’t admit you, consider purchasing our Breathe Better for Life guidebook and companion CD-ROM (www.breathebetterforlife.com). We have built a better breathing exercise and nutrition program based on pulmonary rehabilitation guidelines created by the American Thoracic Society and European Respiratory Society. We created the program specifically for people who can’t get access to a pulmonary rehab program but desire to find ways improve shortness of breath, physical conditioning and their quality of life. As always, you should consult your physician before pursuing our recommended program to make sure the program is appropriate for your circumstances.
The full free text of the Brazilian research study is available be clicking here.
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