(P18) Lack of perceived benefit: Eleven participants reported that they did not consider that pulmonary rehabilitation would have any health benefits for them. This was associated with perceptions of the worth of exercise as a treatment: It is not as if I get some treatment or something; I mean it is just physical exercise, nothing else. (P3) Some individuals (n = 4) felt they were doing enough exercise on their own and therefore did not need to attend the program. Three patients felt they knew all of the exercises that would be performed at the pulmonary rehabilitation program:

I do all the exercise like you do there you know. (P4) Being unwell: The burden of COPD and other comorbidities influenced the decision not to see more attend pulmonary rehabilitation. Four participants felt their respiratory condition would have to improve before they could attend: My breathing on exertion would have to get better. (P17) Five participants indicated that other INCB018424 in vitro medical conditions contributed to their failure to attend. These patients did not consider COPD to be their most significant health issue and expressed fear of exacerbating other medical conditions: I don’t think the emphysema is the worst of my problems by any means. (P13)

Competing demands were associated with non-attendance by five participants. Overseas travel, seeking new accommodation, the burden of other medical treatments such as nebulisation and oxygen therapy, the need

to care for pets, and not wanting to leave their residence unattended were all reported. These comments reflected the relative importance ascribed to pulmonary rehabilitation compared to other demands, or the number of demands being managed. Five participants said they were too old to attend pulmonary rehabilitation, including two patients who thought they did not have long to live. Five participants felt that the energy levels required to attend pulmonary rehabilitation would be too much for them. Four participants and commented that the timing of the program affected their ability to attend, with three of these indicating the program was too early in the day. Nine women and nine men did not complete pulmonary rehabilitation (Table 2), attending between 1 and 12 sessions. Five of the participants had utilised volunteer transport to attend the program. Six of the eighteen non-completers stated that they did not know why they were referred to pulmonary rehabilitation, whilst two participants reported that they were referred because of non-respiratory conditions (heart attack and weight loss). Ten participants indicated that they would like to complete a pulmonary rehabilitation program in the future: I think it would be great actually.