SALT LAKE CITY – Anxiety in patients with chronic obstructive pulmonary disease is common, disruptive, and responds favorably to cognitive behavioral group therapy, Dr. Sandra G. Adams reported at the annual meeting of the American College of Chest Physicians.
Other investigators have shown that clinically significant anxiety occurs in up to half of COPD patients, and that it's associated with greater disability and impairment of quality of life. Moreover, in a prospective five-country Scandinavian study involving 416 COPD patients, anxiety conferred a 76% increase in risk for rehospitalization within 12 months (Eur. Respir. J. 2005;26:414–9).
This raises the possibility–as yet not examined in a clinical trial–that treating anxiety in patients with COPD might reduce rehospitalization, noted Dr. Adams of the University of Texas, San Antonio.
Experts agree COPD is underdiagnosed. And among patients with known COPD, anxiety is also greatly underdiagnosed, she said. For example, only 1 of the 22 patients with severe COPD and moderate to severe anxiety in her randomized trial of cognitive behavioral therapy (CBT) had been diagnosed with anxiety.
Study participants had a mean baseline forced expiratory volume in 1 second of 33% of predicted, indicative of very severe COPD. They also acknowledged having a “somewhat difficult” problem with at least one anxiety symptom on the Prime-MD screening instrument.
Patients were randomized to one group session of CBT per week for 6 weeks or to a general health education class with the same schedule. There were five to seven patients per group. CBT sessions covered relaxation techniques, stress and coping skills, practical goal setting, and general COPD information. The control group received information on COPD, exercise and nutrition, Social Security benefits, and advance directives.
Six weeks after completing the program, patients in the CBT arm showed significant improvement in quality of life, as reflected in a mean 11-point improvement on the St. George's Respiratory Questionnaire. In contrast, scores in the control group worsened by nearly 6 points. Neither group, however, showed a significant change on the Beck Anxiety or Beck Depression inventories.