Low levels of health literacy have been documented in people with COPD (Press et al 2011) which may impact on the effectiveness of written information. However, it has recently been demonstrated that even when high quality, specific information about pulmonary rehabilitation is delivered, using current best practice regarding information presentation and terminology, there may

not Small molecule library clinical trial be improvements in COPD care (Harris et al 2009). This suggests that information alone is insufficient to change behaviours. Data from this study suggest that there is a group of patients who see pulmonary rehabilitation as of minimal value who also have low expectations regarding their future health status, and thus may not consider that the potential benefits of rehabilitation might apply to them. Further consideration is needed of how best to convey the potential benefits of pulmonary rehabilitation to those who are eligible to attend. Such strategies could include utilising SRT1720 cell line peer support and education delivered

by others with COPD who have personal experience of the program. More than half of the participants in this study indicated that difficulty in getting to the pulmonary rehabilitation venue affected their decision to participate, despite the fact that the vast majority lived less than 10 km from the hospital. Both the availability and the cost of transport were cited as barriers to attendance. Over half of the participants lived alone and many relied on public transport or family and friends

to attend pulmonary rehabilitation. Although a volunteer driver program was in place at the hospital where the pulmonary rehabilitation program took place, this had limited capacity and was clearly insufficient to overcome the burden of travel. These results are consistent with previous reports examining attendance at pulmonary rehabilitation (Fischer et al 2007, Taylor et al 2007, Young et al 1999). Current pulmonary rehabilitation guidelines do not only make strong recommendations regarding transport, recognising the cost implications for clinical services (British Thoracic Society 2001). Other guidelines suggest that patients with limited access to transport undergo pulmonary rehabilitation as an inpatient (Nici et al 2006), however this is not available in many settings – including our own. Given the consistency with which travel and transport have been reported as barriers to attendance, this issue requires attention in future program models. A number of participants who did not complete the pulmonary rehabilitation program expressed a preference for programs conducted in the home environment. This was related to both the challenges of travel and the greater feeling of security associated with being at home.