Randomised controlled trial of cognitive behavioural therapy in COPD

Abstract

Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62–4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19–2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49–2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.

A five-step process for designing implementable complex interventions: A worked example using the Tailored intervention for ANxiety and DEpression Management (TANDEM) for patients with chronic obstructive pulmonary disease (COPD)

“…Step One -Review of the literature Dr Karen Heslop Marshall, a clinical academic agreed to be part of the research collaboration, allowing use of her CBT based Lung Manual (42), which had been evaluated in a successful randomized trial (39), as a basis for the development of the TANDEM intervention. We also recognised the importance of providing high quality, standardised information and education.…”

“…We arranged two focus groups for patients and carers. One included COPD patients or carers who had previously experienced CBT (including participants from a speci c CBT trial (39); and one with patients and carers attending a Breathe Easy group (a UK support group run by the British Lung Foundation (BLF) who may, or may not, have experienced CBT.…”

“…ii. PR has an established evidence base for COPD (29)(30)(31) and CBT is showing promise for COPD patients (35,39).…”

Effects of cognitive behavioral therapy on anxiety and depression in patients with chronic obstructive pulmonary disease:A Meta-analysis and Systematic Review

“…A detailed overview of the study flow is presented in Figure 1. Ten studies [12,13,[18][19][20][21][22][23][24][25] Table 3.…”

An Ophthalmic Changes in Patients with Chronic Obstructive Pulmonary Disease: Case-Control Study

“…According to the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD, 2006), the spirometric diagnostic criteria for this disease is the ratio of forced expiratory volume in the first second / forced vital capacity (FEV1 / FVC) of less than 0.7 after the bronchodilator and, depending on the degree of bronchial obstruction, patients were classified into four groups according to established spirometric criteria [12]. Therefore, different groups of COPD patients have systemic manifestations that may compromise functional capacity and cognitive behavior more severely than others and thus reduce quality of life and increase mortality among these individuals [13]. Among the most wellknown manifestations are heart diseases and pulmonary vascular diseases, as well as malnutrition with dysfunction of the skeletal muscles, osteoporosis, anemia, among others [14,15].…”