COPD is a long-term condition that causes inflammation in the lungs, narrowing of the airways, and damaged lung tissue, making breathing difficult. Anxiety often occurs alongside COPD and can mean that patients get less physical activity, leading to loss of fitness, isolation and deteriorating health overall.
The new study found that brief CBT sessions with respiratory nurses reduced feelings of anxiety for patients with COPD and resulted in less frequent use of the accident & emergency department (A&E) and hospital services.
“One of the main symptoms of COPD is breathlessness,” said Dr. Karen Heslop-Marshall, a nurse consultant at Newcastle-upon-Tyne NHS Foundation Trust and Newcastle University and lead researcher on the study. “This is very frightening and often leads to feelings of anxiety. Many health care professionals do not currently screen COPD patients for symptoms of anxiety, even though it can have an impact on their overall health.”
“Feeling anxious has a negative impact on patients’ quality of life and leads to more frequent use of healthcare resources,” she continued. “We wanted to test whether one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and whether this could be a cost-effective intervention.”
According to Heslop-Marshall, 236 patients with a diagnosis of mild to very severe COPD took part in the trial.
Each patient had been screened for anxiety using the HADS-Anxiety Subscale. This is a simple questionnaire that asks patients about their feelings of anxiety and depression over the past week, researchers explained. Scores of between eight and 10 are considered to show mild symptoms, 11-14 indicate moderate symptoms, and scores of more than 15 indicate severe symptoms.
All the patients entered into the study scored eight or higher on the HADS scale. In total, 59 percent of those screened for entry into the study had raised HADS scores, suggesting anxiety is very common in COPD, the researchers reported.
Over a three-month period, patients were either given leaflets on anxiety management or given leaflets, as well as CBT. The CBT sessions coached patients on how to develop coping strategies to deal with the anxiety caused by breathlessness in an effort to help to improve physical activity levels.
All of the patients also received standard medical care, including lung function testing, a medical review, and appropriate drug treatments. If they were eligible, they also received pulmonary rehabilitation, which is a supervised exercise program designed for COPD patients, the researchers said.
After three months, patients completed the HADS-Anxiety questionnaire again to assess how the different treatment methods affected their levels of anxiety.
The researchers found that CBT was more effective in reducing anxiety symptoms in COPD patients compared to leaflets alone. On average, the HADS-Anxiety scale scores of CBT patients improved by 3.4, while patients in the leaflet group improved by just 1.9, according to the study’s findings.
The data also showed no link between a patients’ lung function, measured by how much air a person can breathe out in one second, and their anxiety score. The researchers say this suggests that even patients with mild COPD can feel extremely anxious, and would benefit from this intervention.
“We found that one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and that this could be a cost-effective intervention,” Heslop-Marshall said. “Although the CBT intervention initially resulted in added costs, as respiratory nurses required training in CBT skills, this was balanced by the savings made thanks to less frequent need of hospital and A&E services.”
“Reducing the levels of anxiety patients experience has a significant impact on their quality of life, as well as their ability to keep physically active and may improve survival in the long-term,” she added. “Our research shows that front-line respiratory staff can deliver this intervention efficiently and effectively.”
The study was published in ERJ Open Research.
Source: European Lung Foundation