The Effects of Smoking Status on Patient Outcomes in Pulmonary Rehabilitation

PURPOSE: This study examined the effects of smoking status upon pulmonary rehabilitation (PR) entry (current vs never/former) on clinical outcomes of PR using the American Association of Cardiovascular and Pulmonary Rehabilitation PR Registry. METHODS: Participants with chronic obstructive pulmonary disease (N = 41,087) were from 319 PR programs in the US contributing data between 2013 and 2021. Baseline characteristics included demographics (age, sex, race, education, insurance), body mass index, and smoking status (current vs former/never). Outcomes included the number of PR sessions attended, functional capacity (6-minute walk distance [6MWD]), depression and anxiety symptoms, and dyspnea. RESULTS: Current smoking was reported by 14% of participants. Compared to those who never or formerly smoked, those currently smoking were younger (64.1 ± 8.8 vs 70.8 ± 8.9 years), more likely to have Medicaid (17% vs 7%), had lower body mass index (28.3 ± 8.2 vs 30.0 ± 7.9 kg/m2), greater 6MWD (906.9 ± 343.0 vs 841.3 ± 350.6 ft), and higher depression (8.5 ± 6.1 vs 6.3 ± 5.3) and anxiety (6.9 ± 4.6 vs 5.5 ± 4.3) symptoms. At PR completion, those who smoke attended fewer sessions (14.9 ± 10.8 vs 18.7 ± 10.8 sessions), yet had similar improvements in 6MWD, anxiety symptoms, and dyspnea, but less improvement in depression symptoms (+0.52 [95% CI, 0.35-0.69]) compared to those who never or formerly smoked. CONCLUSION: Despite attending fewer PR sessions, patients with chronic obstructive pulmonary disease who currently smoke have clinically significant improvements in functional capacity, anxiety symptoms, and dyspnea comparable to patients who never or formerly smoked, yet their depression symptoms remain higher at program completion. Thus, PR programs should not restrict entry based on smoking status.