Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD

Güell, Rosa; Resqueti, Vanesa; Sangenis, Mercedes; Morante, Luís Fernando Morales; Martorell, Bernardi; Casán, Pere; Guyatt, Gordon

doi:10.1378/chest.129.4.899

Cited by 111 publications

(59 citation statements)

References 26 publications

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“…Interestingly, there is evidence that pulmonary rehabilitation can improve psychosocial morbidity in COPD, including depression. 47 …”

Section: Depressionmentioning

confidence: 99%

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Molena

2010

Primary Care Respiratory Journal

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Introduction: In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality.

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“…Interestingly, there is evidence that pulmonary rehabilitation can improve psychosocial morbidity in COPD, including depression. 47 …”

Section: Depressionmentioning

confidence: 99%

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Molena

2010

Primary Care Respiratory Journal

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“…In COPD patients, several studies have shown that pulmonary rehabilitation reduces anxiety [37,39,[62][63][64][65]. EMERY et al [66] demonstrated that supervised exercise training performed over 10 weeks, combined with education sessions that included stress management techniques, yielded significant reductions in symptoms of anxiety.…”

Section: Pharmacological Therapymentioning

confidence: 99%

Anxiety and depression in end-stage COPD

Hill

Geist²,

Goldstein³

et al. 2008

European Respiratory Journal

223

137

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Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), estimates of their prevalence vary considerably. This probably reflects the variety of scales and methods used to measure such symptoms. Regardless of whether anxiety and depression are considered separately or as a single construct, their impact on COPD patients is important.A heightened experience of dyspnoea is likely to be a contributing factor to anxiety. Feelings of depression may be precipitated by the loss and grief associated with the disability of COPD. Smoking has been associated with nicotine addiction, and the factors that contribute to smoking may also predispose to anxiety and depressive disorders.Randomised controlled trials indicate that exercise training and carefully selected pharmacological therapy are often effective in ameliorating anxiety and depression. Most medical illnesses are influenced by the psychological responses and coping mechanisms that patients use. However, anxiety and depression are associated with dyspnoea, fatigue and altered sleep, all of which also occur in COPD.An understanding of the psychological history and coping mechanisms of patients and the role of anxiety and depressive reactions to illness may enable clinicians to reduce these symptoms and improve quality of life among patients with chronic obstructive pulmonary disease.KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression C hronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction that is not fully reversible [1]. In addition to the primary pulmonary pathology, the impact of secondary skeletal muscle dysfunction on exercise capacity and survival is well established [2,3]. Psychological impairments, ranging from feelings of depression and anxiety to full diagnostic mental disorders, although prevalent in this population, have received less interest. As COPD is incurable, therapeutic interventions aim to optimise function and slow disease progression [4]. Attention has focused predominantly on the effectiveness of strategies such as smoking cessation [5], longterm oxygen therapy (LTOT) [6,7], influenza vaccines [8], respiratory-specific pharmacological management [9], surgical options [10], conditioning of the peripheral muscles with graduated exercise training [11] and chronic disease selfmanagement strategies [12].Despite the prevalence of depression and anxiety and their impact on the morbidity associated with COPD, these psychological consequences of the disease are rarely addressed, at least in the respiratory medicine community. The purpose of the present review is to raise awareness among pulmonologists, general practitioners and allied health professionals to the secondary psychological impairment associated with COPD. Although anxiety and depression often coexist, they represent separate constructs [13]. Broader reviews of the psychological characteristics of patients with COPD are available [14]. ANXIETY Classification and diagnostic cr...

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“…The Chronic Respiratory Questionnaire (CRQ) is a widely used diseasespecific questionnaire that has been shown to be reliable, valid and responsive in COPD patients [6]. It has also been used in more severe patients [7][8][9]. However, it was not designed for patients with chronic respiratory failure and might not include items specifically important for these patients.…”

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confidence: 99%

Health-related quality of life in COPD patients with chronic respiratory failure

Duiverman¹,

Wempe²,

Bladder³

et al. 2008

European Respiratory Journal

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The Maugeri Respiratory Failure (MRF-28) and Severe Respiratory Insufficiency (SRI) questionnaires were recently developed to assess health-related quality of life (HRQoL) in patients with chronic respiratory failure, although not exclusively in chronic obstructive pulmonary disease (COPD) patients. The aim of the present study was to investigate whether the MRF-28 and SRI are reliable and valid HRQoL questionnaires in COPD patients with chronic hypercapnic respiratory failure (CHRF).In total, 72 COPD patients with CHRF underwent pulmonary function and exercise testing, and completed the MRF-28, the SRI, the Chronic Respiratory Questionnaire (CRQ), the Hospital Anxiety and Depression Scale, the Groningen Activity and Restriction Scale and two dyspnoea indexes.Physical domain scores of the questionnaires correlated with exercise tolerance, dyspnoea and daily activities, while psychological domains correlated strongly with anxiety and depression. Anxiety scores accounted for 51 and 56% of the total explained variance in total CRQ and SRI scores, respectively. The emphasis of the MRF-28 was restrictions in activities of daily living (52% of total variance).In conclusion, the present study showed that the Maugeri Respiratory Failure and Severe Respiratory Insufficiency questionnaires were reliable and valid questionnaires in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure. While the emphasis in the Maugeri Respiratory Failure questionnaire is on activities of daily living, the Severe Respiratory Insufficiency questionnaire, like the Chronic Respiratory Questionnaire, is more related to anxiety and depression. KEYWORDS: Chronic obstructive pulmonary disease, quality of life, respiratory insufficiency C hronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1]. As COPD is a progressive disease, the number of COPD patients with severe disease and chronic respiratory failure will increase in the coming years. It has been shown that patients with chronic respiratory failure have poor survival. A 5-yr mortality of 70-100% was reported [2]. Survival rates are difficult to improve once patients have become respiratory insufficient. Despite treatment with long-term oxygen or home mechanical ventilation (HMV), median survival was still only 3 yrs [3].Although survival rates are difficult to improve, therapeutic interventions in severe COPD might nevertheless improve health-related quality of life (HRQoL) [4,5]. The Chronic Respiratory Questionnaire (CRQ) is a widely used diseasespecific questionnaire that has been shown to be reliable, valid and responsive in COPD patients [6]. It has also been used in more severe patients [7][8][9]. However, it was not designed for patients with chronic respiratory failure and might not include items specifically important for these patients. Therefore, a need was felt for questionnaires specific for patients with respiratory failure [10]. The Maugeri Respiratory Failure (MRF-28) and Severe Re...

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Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD

Cited by 111 publications

References 26 publications

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Anxiety and depression in end-stage COPD

Health-related quality of life in COPD patients with chronic respiratory failure

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