‘The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease

Abstract

Background:Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture.Aims:To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status.Methods:Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups.Results:After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.Conclusion:The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.

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.…”

“…1 item [12] The study did not report anxiety scores after intervention, the rest [13,[18][19][20][21][22][23][24][25] The results of the pooled study were SMD = -0.28, 95% CI [-0.51, 0.05], P = 0.02, and the difference was statistically significant (Figure 4). Subgroup analysis revealed no significant difference in the magnitude of difference between shorter and longer programs (P = 0.53).However, the effect in longer programs was statistically significant, while that of shorter programs was not data for this outcome were statistically heterogeneous (I 2 =70%).…”

Managing breathlessness: a palliative care approach

“…A simple cognitive approach would include identifying triggers to patients' anxiety and learning how to overcome them, as well as helping patients to challenge unhelpful thoughts, relaxation exercises, mindfulness and distraction techniques are all useful. A RCT of 222 patients with COPD with examining the effectiveness of a cognitive-behavioural manual and self-management strategies versus information booklets showed a reduction in emergency department visits and hospital admissions at 12 months, and improved breathlessness, anxiety and depression at 6 months in the group allocated to receive the manual 30. Manuals such as this may be useful as maintenance therapy for patients by empowering them to have mastery over the symptom.…”

Using health psychology techniques to manage chronic physical symptoms

“…This in turn exacerbates breathlessness. Carers or other observers of breathlessness and panic may also respond with alarm, due to feelings of helplessness, inadvertently reinforcing the individual's panic and escalating the problem (Howard and Dupont, 2014). Thinking errors also lead to unhelpful behaviours, for example, in people who are experiencing breathlessness, concurrent panic has been linked to overuse of medication, constant over-vigilance for signs of breathlessness and inappropriate use of health services (Heslop and Foley, 2009).…”

“…Understanding of common thinking errors and behaviours associated with chronic physical symptoms has led to the development of effective cognitive-behavioural therapy (CBT) for all the symptoms discussed here:  Non-malignant pain (Glombiewski et al, 2010)  Chest pain in people with diagnosed CHD (Lewin et al, 2002)  Chronic stable angina (Moore et al, 2007)  Non-cardiac chest pain (Kisely et al, 2012)  Palpitations (Jonsbu et al, 2010)  Breathlessness (Coventry and Gellatly, 2008;Howard and Dupont, 2014)  Fatigue (White et al, 2011) Protocols for specific symptoms vary, but the CBT approach is to challenge misconceptions that all symptoms are bad and should be avoided. CBT therapists use education, behavioural experiments (helping the patient to test the effect of activity) and opportunities to experience symptoms in a safe "The damage to my heart is permanent"…”