1
|
Miao X, Han Y, Wu Z, Jin X, Niu M, Zhao Q, Lu X. Reliability, Validity, Modification and Expansion of the Chinese Version of the Disease-Specific Anxiety Questionnaire for Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1047-1060. [PMID: 38765767 PMCID: PMC11102147 DOI: 10.2147/copd.s455171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To translate a disease-specific anxiety questionnaire on chronic obstructive pulmonary disease (COPD) and test its reliability and validity in China. Patients and Methods The German version of the revised COPD Anxiety Questionnaire (CAF-R) was initially validated using step-by-step translation, back-translation, and cross-cultural adaptation. The reliability and validity of the Chinese version of the CAF-R (CAF-R-CN) were tested among 448 patients with COPD (mean age =71.42±9.33 years, 17.2% female) from four medical institutions in Suzhou, Jiangsu Province, using convenience sampling, from April 2022 to June 2023. Results The CAF-R-CN included six dimensions with a total of 25 items. The item-level content validity index was 0.860-1.000; the scale-level content validity index was 0.920. The structural validity χ2/df was 2.326, the root mean square error of approximation was 0.077, the comparative fit index was 0.924, and the Tucker-Lewis index was 0.912. The six-dimensional internal consistency index Cronbach's α coefficient was 0.696-0.910, and the test-retest reliability was 0.949. An optimal cut-off score of 50.5 was selected with a sensitivity of 0.786 and specificity of 0.870. Conclusion The CAF-R-CN had satisfactory reliability and validity and can be used to identify and assess anxiety in COPD patients with a Chinese cultural background.
Collapse
Affiliation(s)
- XiaoLang Miao
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Yanxia Han
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zhenyun Wu
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xiaoliang Jin
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Mei’e Niu
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Qian Zhao
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xiangmin Lu
- School of Nursing, Soochow University, Suzhou, People’s Republic of China
| |
Collapse
|
2
|
Papi A, Faner R, Pavord I, Baraldi F, McDonald VM, Thomas M, Miravitlles M, Roche N, Agustí A. From treatable traits to GETomics in airway disease: moving towards clinical practice. Eur Respir Rev 2024; 33:230143. [PMID: 38232989 DOI: 10.1183/16000617.0143-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/24/2023] [Indexed: 01/19/2024] Open
Abstract
The treatable traits approach represents a strategy for patient management. It is based on the identification of characteristics susceptible to treatments or predictive of treatment response in each individual patient. With the objective of accelerating progress in research and clinical practice relating to such a treatable traits approach, the Portraits event was convened in Barcelona, Spain, in November 2022. Here, while reporting the key concepts that emerged from the discussions during the meeting, we review the current state of the art related to treatable traits and chronic respiratory diseases management, and we describe the possible actions that clinicians can take in clinical practice to implement the treatable traits framework. Furthermore, we explore the new concept of GETomics and the new models of research in the field of COPD.
Collapse
Affiliation(s)
- Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Rosa Faner
- University of Barcelona, Biomedicine Department, FCRB-IDIBAPS, Centro de Investigación Biomedica en Red M.P. (CIBER), Barcelona, Spain
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Vanessa M McDonald
- School of Nursing and Midwifery, The University of Newcastle, NHMRC Centre of Excellence in Asthma Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Programme and Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Marc Miravitlles
- Pneumology Department Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Nicholas Roche
- Respiratory Medicine Department, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, AP-HP and Université Paris Cité, Paris, France
| | - Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain
- Pulmonary Service, Respiratory Institute, Clinic Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
4
|
Evans R, Doe G. Can the curse of mood disorders in COPD be lifted and enable pulmonary rehabilitation? Eur Respir J 2023; 62:2301538. [PMID: 37918881 DOI: 10.1183/13993003.01538-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Rachael Evans
- NIHR Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Gillian Doe
- NIHR Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
5
|
Taylor SJC, Sohanpal R, Steed L, Marshall K, Chan C, Yaziji N, Barradell AC, Font-Gilabert P, Healey A, Hooper R, Kelly MJ, Mammoliti KM, Priebe S, Rajasekaran A, Roberts CM, Rowland V, Singh SJ, Smuk M, Underwood M, Waseem S, White P, Wileman V, Pinnock H. Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial. Eur Respir J 2023; 62:2300432. [PMID: 37620042 PMCID: PMC10620475 DOI: 10.1183/13993003.00432-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control). METHODS People with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6-8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use. RESULTS The intervention did not improve anxiety (HADS-A mean difference -0.60, 95% CI -1.40-0.21) or depression (HADS-D mean difference -0.66, 95% CI -1.39-0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective. CONCLUSION This trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.
Collapse
Affiliation(s)
- Stephanie J C Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Ratna Sohanpal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Karen Marshall
- Chest Clinic, RVI Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amy C Barradell
- NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Paulino Font-Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Healey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Moira J Kelly
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- WHO Collaborating Centre on Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Arvind Rajasekaran
- Department of Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - C Michael Roberts
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Vickie Rowland
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sally J Singh
- Department of Respiratory Sciences, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Sarah Waseem
- Women's Health Division, University College Hospital, London, UK
| | - Patrick White
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Vari Wileman
- Health Psychology, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Wileman V, Rowland V, Kelly M, Steed L, Sohanpal R, Pinnock H, Taylor SJC. Implementing psychological interventions delivered by respiratory professionals for people with COPD. A stakeholder interview study. NPJ Prim Care Respir Med 2023; 33:35. [PMID: 37880342 PMCID: PMC10600190 DOI: 10.1038/s41533-023-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Implementing psychological interventions in healthcare services requires an understanding of the organisational context. We conducted an interview study with UK National Health Service stakeholders to understand the barriers and facilitators for implementing psychological interventions for people with chronic obstructive pulmonary disorder (COPD). We used TANDEM as an exemplar intervention; a psychological intervention recently evaluated in a randomised controlled trial. Twenty participants providing care and/or services to people with COPD were purposively sampled from NHS primary/secondary care, and commissioning organisations. Participants were recruited via professional networks and referrals. Verbatim transcripts of semi-structured interviews were analysed using thematic analysis. Four themes were identified: (1) Living with COPD and emotional distress affects engagement with physical and psychological services; (2) Resource limitations affects service provision in COPD; (3) Provision of integrated care is important for patient well-being; and (4) Healthcare communication can be an enabler or a barrier to patient engagement. People need support with physical and psychological symptoms inherent with COPD and healthcare should be provided holistically. Respiratory healthcare professionals are considered able to provide psychologically informed approaches, but resources must be available for training, staff supervision and service integration. Communication between professionals is vital for clear understanding of an intervention's aims and content, to facilitate referrals and uptake. There was widespread commitment to integrating psychological and physical care, and support of respiratory healthcare professionals' role in delivering psychological interventions but significant barriers to implementation due to concerns around resources and cost efficiency. The current study informs future intervention development and implementation.
Collapse
Affiliation(s)
- V Wileman
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
- Health Psychology, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK.
| | - V Rowland
- School of Population Health and Environmental Sciences, King's College London, Addison House, Guy's Campus, London Bridge, London, SE1 9RT, UK
| | - M Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - L Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - R Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - H Pinnock
- Allergy and Respiratory Research Group, Usher Institute, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - S J C Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| |
Collapse
|
7
|
Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Heslop Marshall K, Vogiatzis I. Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD. ERJ Open Res 2023; 9:00074-2023. [PMID: 37701362 PMCID: PMC10493712 DOI: 10.1183/23120541.00074-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. Methods 32 patients with COPD (mean±sd forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. Results The magnitude of improvement across physical activity outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by -2 units, 95% CI -4-1 units) and 6MWD (by 33±20 m). Conclusions Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.
Collapse
Affiliation(s)
- Matthew Armstrong
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Laura McNeillie
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Francesca Chambers
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynsey Wakenshaw
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Graham Burns
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| |
Collapse
|
8
|
Hutchinson A, Pickering A, Williams P, Johnson M. Predictors of hospital admission when presenting with acute-on-chronic breathlessness: Binary logistic regression. PLoS One 2023; 18:e0289263. [PMID: 37582083 PMCID: PMC10426999 DOI: 10.1371/journal.pone.0289263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions. Acute-on-chronic breathlessness is a reason for 20% of emergency presentations by ambulance with 69% of these being admitted. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness. AIM To examine predictors of emergency department departure status in people with acute-on-chronic breathlessness. DESIGN, SETTING AND METHOD Secondary analysis of patient-report survey and clinical record data from consecutive eligible attendees by ambulance. Variables associated with emergency department departure status (unifactorial analyses; p<0.05) were included in a binary logistic regression model. The study was conducted in a single tertiary hospital. Consecutive survey participants presenting in May 2015 with capacity were eligible. 1,212/1,345 surveys were completed. 245/1,212 presented with acute-on-chronic breathlessness, 171 of whom consented to clinical record review and were included in this analysis. RESULTS In the final model, the odds of admission were increased with every extra year of age [OR 1.041 (95% CI: 1.016 to 1.066)], having talked to a specialist doctor about breathlessness [9.262 (1.066 to 80.491)] and having a known history of a heart condition [4.177 (1.680 to 10.386)]. Odds of admission were decreased with every percentage increase in oxygen saturation [0.826 (0.701 to 0.974)]. CONCLUSION Older age, lower oxygen saturation, having talked to a specialist, and having history of a cardiac condition predict hospital admission in people presenting to the emergency department with acute-on-chronic breathlessness. These clinical factors could be assessed in the community and may inform the decision regarding conveyance.
Collapse
Affiliation(s)
| | - Alastair Pickering
- Emergency Department, Consultant in Emergency Medicine, Hull Royal Infirmary, Hull University Teaching Hospitals Trust, Hull, United Kingdom
| | - Paul Williams
- Emergency Department, Consultant in Emergency Medicine, Hull Royal Infirmary, Hull University Teaching Hospitals Trust, Hull, United Kingdom
| | | |
Collapse
|
9
|
Vontetsianos A, Karadeniz Güven D, Betka S, Souto-Miranda S, Marillier M, Price OJ, Hui CY, Sivapalan P, Jácome C, Aliverti A, Kaltsakas G, Kolekar SB, Evans RA, Vagheggini G, Vicente C, Poberezhets V, Bayat S, Pinnock H, Franssen FM, Vogiatzis I, Chaabouni M, Gille T. ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly. ERJ Open Res 2023; 9:00194-2023. [PMID: 37583963 PMCID: PMC10423988 DOI: 10.1183/23120541.00194-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 08/17/2023] Open
Abstract
It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of the laboratory-based science, clinical trials and qualitative research that were presented during the 2022 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, mobile/electronic health (m-health/e-health), clinical respiratory physiology, exercise and functional imaging.
Collapse
Affiliation(s)
- Angelos Vontetsianos
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Damla Karadeniz Güven
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Sophie Betka
- Neuro-X Institute and Brain Mind Institute, Laboratory of Cognitive Neuroscience, Geneva, Switzerland
- École Polytechnique Fédérale de Lausanne, Center for Neuroprosthetics, Faculty of Life Sciences, Geneva, Switzerland
| | - Sara Souto-Miranda
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences (DCM), University of Aveiro, Aveiro, Portugal
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mathieu Marillier
- Université Grenoble Alpes Laboratoire HP2, Inserm U1300, Grenoble, France
- CHU Grenoble Alpes, Grenoble, France
- Queen's University and Kingston General Hospital, Laboratory of Clinical Exercise Physiology, Kingston, ON, Canada
| | - Oliver J. Price
- University of Leeds, School of Biomedical Sciences, Faculty of Biological Sciences, Leeds, UK
- University of Leeds, Leeds Institute of Medical Research at St James's, Leeds, UK
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chi Yan Hui
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
| | - Pradeesh Sivapalan
- Herlev and Gentofte University Hospital, Section of Respiratory Medicine, Hellerup, Denmark
| | - Cristina Jácome
- University of Porto, Faculty of Medicine, CINTESIS@RISE, MEDCIDS, Porto, Portugal
| | - Andrea Aliverti
- Politecnico di Milano, Dipartimento di Elettronica Informazione e Bioingegneria, Milan, Italy
| | - Georgios Kaltsakas
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Lane Fox Respiratory Service, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shailesh B. Kolekar
- Zealand University Hospital Roskilde, Department of Internal Medicine, Roskilde, Denmark
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - Rachael A. Evans
- University Hospitals of Leicester NHS Trust, NIHR Leicester Biomedical Research Centre – Respiratory, Leicester, UK
- University of Leicester, Department of Respiratory Sciences, Leicester, UK
| | - Guido Vagheggini
- Azienda USL Toscana Nord Ovest, Department of Medical Specialties, Chronic Respiratory Failure Care Pathway, Volterra, Italy
- Fondazione Volterra Ricerche Onlus, Volterra, Italy
| | | | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Sam Bayat
- CHU Grenoble Alpes, Service de Pneumologie et de Physiologie, Grenoble, France
- Université Grenoble Alpes, Inserm UA07 STROBE, Grenoble, France
| | - Hilary Pinnock
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
| | - Frits M.E. Franssen
- CIRO, Department of Research and Development, Horn, The Netherlands
- Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Ioannis Vogiatzis
- Northumbria University Newcastle, Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Malek Chaabouni
- Asklepios Klinik Altona, Department of Pulmonology and Thoracic Oncology, Hamburg, Germany
| | - Thomas Gille
- Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France
- Université Sorbonne Paris Nord, UFR de Santé Médecine Biologie Humaine, Inserm U1272 “Hypoxia and the Lung”, Bobigny, France
| |
Collapse
|
10
|
Cox CE, Kelleher SA, Parish A, Olsen MK, Bermejo S, Dempsey K, Jaggers J, Hough CL, Moss M, Porter LS. Feasibility of Mobile App-based Coping Skills Training for Cardiorespiratory Failure Survivors: The Blueprint Pilot Randomized Controlled Trial. Ann Am Thorac Soc 2023; 20:861-871. [PMID: 36603136 PMCID: PMC10257028 DOI: 10.1513/annalsats.202210-890oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Rationale: Psychological distress symptoms are common among patients recently hospitalized with cardiorespiratory failure, yet there are few effective postdischarge therapies that are relevant to their experiences. Objectives: To determine the feasibility and clinical impact of two different versions of a month-long self-guided mobile app-based coping skills program called Blueprint in comparison to usual care (UC) control. Methods: Patients hospitalized with a serious cardiopulmonary diagnoses were recruited from adult intensive care units and stepdown units at a large academic medical center. Participants with elevated psychological distress symptoms just after discharge were randomized in a 1:1:1 ratio to Blueprint with a therapist (BP/therapist), Blueprint without a therapist (BP/no therapist), or UC control. All study procedures were conducted remotely. Blueprint is a self-guided, symptom-responsive, mobile app-based adaptive coping skills program with 4 themed weeks with different daily audio, video, and text content. Participants completed surveys via the app platform at baseline and 1 and 3 months later. The primary outcome was feasibility. Additional outcomes included the HADS (Hospital Anxiety and Depression Scale) total score, the PTSS (Post-Traumatic Stress Scale), and a 100-point quality of life visual analog scale. Results: Of 63 patients who consented, 45 (71%) with elevated distress were randomized to BP/therapist (n = 16 [36%]), BP/no therapist (n = 14 [31%]), and UC (n = 15 [33%]). Observed rates were similar to target feasibility benchmarks, including consented patients who were randomized (71.4%), retention (75.6%), and intervention adherence (97% with weekly use). Estimated mean differences (95% confidence intervals) at 1 month compared with baseline included: HADS total (BP/therapist, -3.8 [-6.7 to -0.6]; BP/no therapist, -4.2 [-7.6 to -0.0]; UC, -3.4 [-6.6 to 0.2]); PTSS (BP/therapist, -6.7 [-11.3 to -2.1]; BP/no therapist, -9.1 [-14.4 to -3.9]; UC, -4.2 [-10.8 to 2.3]); and quality of life (BP/therapist, -4.5 [-14.3 to 4.6]; BP/no therapist, 14.0 [-0.9 to 29.0]; UC, 8.7 [-3.5 to 20.9]). Conclusions: Among survivors of cardiorespiratory failure, a mobile app-based postdischarge coping skills training intervention demonstrated evidence of feasibility and clinical impact compared with UC control. A larger trial is warranted to test the efficacy of this approach. Clinical trial registered with ClinicalTrials.gov (NCT04329702).
Collapse
Affiliation(s)
- Christopher E. Cox
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | | | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Maren K. Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Santos Bermejo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Katelyn Dempsey
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Jennie Jaggers
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Catherine L. Hough
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Sciences University, Portland, Oregon; and
| | - Marc Moss
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Colorado
| | | |
Collapse
|
11
|
Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
Collapse
Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | | |
Collapse
|
12
|
De Luca SN, Chan SMH, Dobric A, Wang H, Seow HJ, Brassington K, Mou K, Alateeq R, Akhtar A, Bozinovski S, Vlahos R. Cigarette smoke-induced pulmonary impairment is associated with social recognition memory impairments and alterations in microglial profiles within the suprachiasmatic nucleus of the hypothalamus. Brain Behav Immun 2023; 109:292-307. [PMID: 36775074 DOI: 10.1016/j.bbi.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/29/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major, incurable respiratory condition that is primarily caused by cigarette smoking (CS). Neurocognitive disorders including cognitive dysfunction, anxiety and depression are highly prevalent in people with COPD. It is understood that increased lung inflammation and oxidative stress from CS exposure may 'spill over' into the systemic circulation to promote the onset of these extra-pulmonary comorbidities, and thus impacts the quality of life of people with COPD. The precise role of the 'spill-over' of inflammation and oxidative stress in the onset of COPD-related neurocognitive disorders are unclear. The present study investigated the impact of chronic CS exposure on anxiety-like behaviors and social recognition memory, with a particular focus on the role of the 'spill-over' of inflammation and oxidative stress from the lungs. Adult male BALB/c mice were exposed to either room air (sham) or CS (9 cigarettes per day, 5 days a week) for 24 weeks and were either daily co-administered with the NOX2 inhibitor, apocynin (5 mg/kg, in 0.01 % DMSO diluted in saline, i.p.) or vehicle (0.01 % DMSO in saline) one hour before the initial CS exposure of the day. After 23 weeks, mice underwent behavioral testing and physiological diurnal rhythms were assessed by monitoring diurnal regulation profiles. Lungs were collected and assessed for hallmark features of COPD. Consistent with its anti-inflammatory and oxidative stress properties, apocynin treatment partially lessened lung inflammation and lung function decline in CS mice. CS-exposed mice displayed marked anxiety-like behavior and impairments in social recognition memory compared to sham mice, which was prevented by apocynin treatment. Apocynin was unable to restore the decreased Bmal1-positive cells, key in cells in diurnal regulation, in the suprachiasmatic nucleus of the hypothalamus to that of sham levels. CS-exposed mice treated with apocynin was associated with a restoration of microglial area per cell and basal serum corticosterone. This data suggests that we were able to model the CS-induced social recognition memory impairments seen in humans with COPD. The preventative effects of apocynin on memory impairments may be via a microglial dependent mechanism.
Collapse
Affiliation(s)
- Simone N De Luca
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Aleksandar Dobric
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hao Wang
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Huei Jiunn Seow
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Kurt Brassington
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Kevin Mou
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Rana Alateeq
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Alina Akhtar
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Steven Bozinovski
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| |
Collapse
|
13
|
Patel H, Shah JR, Patel DR, Avanthika C, Jhaveri S, Gor K. Idiopathic pulmonary fibrosis: Diagnosis, biomarkers and newer treatment protocols. Dis Mon 2022:101484. [DOI: 10.1016/j.disamonth.2022.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
14
|
Jha A, Ward T, Walker S, Goodwin AT, Chalmers JD. Review of the British Thoracic Society Winter Meeting 2021, 24-26 November 2021. Thorax 2022; 77:1030-1035. [PMID: 35907640 DOI: 10.1136/thorax-2022-219150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
The Winter Meeting of the British Thoracic Society (BTS) is a platform for the latest clinical and scientific research in respiratory medicine. This review summarises the key symposia and presentations from the BTS Winter Meeting 2021 held online due to the COVID-19 pandemic.
Collapse
Affiliation(s)
- Akhilesh Jha
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Tom Ward
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Steven Walker
- School of Clinical Sciences, University of Bristol Academic Respiratory Unit, Westbury on Trym, UK
| | - Amanda T Goodwin
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| |
Collapse
|
15
|
Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159101. [PMID: 35897469 PMCID: PMC9368558 DOI: 10.3390/ijerph19159101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 12/10/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses.
Collapse
|
16
|
Pyszora A, Lewko A. Non-pharmacological Management in Palliative Care for Patients With Advanced COPD. Front Cardiovasc Med 2022; 9:907664. [PMID: 35924211 PMCID: PMC9339631 DOI: 10.3389/fcvm.2022.907664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.
Collapse
Affiliation(s)
- Anna Pyszora
- Palliative Care Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
- *Correspondence: Anna Pyszora
| | - Agnieszka Lewko
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| |
Collapse
|
17
|
L S, V W, R S, Mj K, H P, Sjc T. Enhancing and assessing fidelity in the TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) trial: development of methods and recommendations for research design. BMC Med Res Methodol 2022; 22:163. [PMID: 35668365 PMCID: PMC9171991 DOI: 10.1186/s12874-022-01642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of complex interventions for management of chronic conditions has become increasingly common, with guidance now provided. Fidelity (whether the intervention is designed, delivered and received as intended) is critical to understanding if, and how an intervention works (or not). However, methods for achieving this are still evolving. This study describes the methods used in the TANDEM trial - a large multicentre study evaluating the impact of a cognitive behavioural intervention preceding routine pulmonary rehabilitation for people with chronic obstructive pulmonary disease and anxiety and or depression. Results for enhancement and training aspects of fidelity, are presented. METHODS Using the National Institute for Health Behaviour Change Consortium (NIH BCC) framework of fidelity, a set of enhancement strategies and a fidelity measurement strategy were developed with input from a multidisciplinary team. The Cognitive First Aid Rating Scale (CFARS) was used to assess Facilitator (the respiratory professional delivering TANDEM) therapeutic competence at the end of the initial training and throughout treatment delivery (on a randomly selected set of cases). A TANDEM specific treatment adherence measure was developed following previously recommended procedures. Together these (the CFARS and adherence measure) comprised the TANDEM treatment delivery fidelity tool. RESULTS Hiring of respiratory professionals to the initial training programme was successful, with 44% of those expressing initial interest in being a Facilitator successfully completing the process. Video recordings of potential Facilitators conducting standardized patient role plays at the end of the initial training demonstrated fidelity of training. CONCLUSIONS Addressing fidelity in complex intervention trials is a time and resource intensive process but has significant potential to increase understanding of results and strengthen the evidence base for effective interventions. By defining a full fidelity assessment method prior to analysis we aimed to minimise bias when interpreting results. TRIAL REGISTRATION ISRCTN59537391 . Registered on 20 March 2017. Trial protocol version 6.0, 22 April 2018. Process evaluation protocol version 4.0, 1 November 2020.
Collapse
Affiliation(s)
- Steed L
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
| | - Wileman V
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Sohanpal R
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Kelly Mj
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Pinnock H
- Allergy and Respiratory Research Group, Usher Institute, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Taylor Sjc
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| |
Collapse
|
18
|
Kelly C, Heslop-Marshall K, Jones S, Roberts NJ. Self-management in chronic lung disease: what is missing? Breathe (Sheff) 2022; 18:210179. [PMID: 36338256 PMCID: PMC9584548 DOI: 10.1183/20734735.0179-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Self-management, as a strategy to support those living with chronic respiratory conditions such as asthma and COPD, has been widely advocated in guidelines and adopted in practice. However, there can be a disconnect between the goals of patients and healthcare professionals. Goals and barriers to self-management are often compounded by the complex social, emotional and medical needs of patients. People living with chronic respiratory conditions also often have symptoms of anxiety and depression, which can impact on self-management. Self-management therefore requires patients and healthcare professionals to work together and it is essential to involve patients when designing, implementing and evaluating self-management interventions. Patient preferences are clearly important and goal setting needs an individual, flexible and responsive approach from healthcare professionals, which aligns to a more personalised approach to management of treatable traits and the burden of disease. To achieve these goals, healthcare professionals need education to support patients in self-management and behaviour change. This approach should lead to shared decision-making and partnership working that puts the patient right at the centre of their care. Self-management is often effective in chronic respiratory disease and can improve symptoms and reduce healthcare burden. Yet patients rarely feature in the design or implementation of interventions; are patients as active partners the missing ingredient?https://bit.ly/3LiqhVg
Collapse
|
19
|
Fu Y, Chapman EJ, Boland AC, Bennett MI. Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliat Med 2022; 36:770-782. [PMID: 35311415 PMCID: PMC9087316 DOI: 10.1177/02692163221079697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care. AIM To provide a pragmatic overview of clinical guidelines and produce evidence-based recommendations for severe COPD. Interventions for which there is inconsistent evidence to support their use and areas requiring further research were identified. DESIGN Practice review of guidelines supported by scoping review methodology to examine the evidence reporting the use of guideline-recommended interventions. DATA SOURCES An electronic search was undertaken in MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Database of Systematic Reviews, complemented by web searching for guidelines and publications providing primary evidence (July 2021). Guidelines published within the last 5 years and evidence in the last 10 years were included. RESULTS Severe COPD should be managed using a multidisciplinary approach with a holistic assessment. For stable patients, long-acting beta-agonist/long-acting muscarinic antagonist and pulmonary rehabilitation are recommended. Low dose opioids, self-management, handheld fan and nutritional support may provide small benefits, whereas routine corticosteroids should be avoided. For COPD exacerbations, systematic corticosteroids, non-invasive ventilation and exacerbation action plans are recommended. Short-acting inhaled beta-agonists and antibiotics may be considered but pulmonary rehabilitation should be avoided during hospitalisation. Long term oxygen therapy is only recommended for patients with chronic severe hypoxaemia. Short-acting anticholinergic inhalers, nebulised opioids, oral theophylline or telehealth are not recommended. CONCLUSIONS Recommended interventions by guidelines are not always supported by high-quality evidence. Further research is required on efficacy and safety of inhaled corticosteroids, antidepressants, benzodiazepines, mucolytics, relaxation and breathing exercises.
Collapse
Affiliation(s)
- Yu Fu
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison C Boland
- Department of Respiratory Medicine, St
James’s University Hospital, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
20
|
The effectiveness of pulmonary rehabilitation on chronic obstructive pulmonary disease patients with concurrent presence of comorbid depression and anxiety. Respir Med 2022; 197:106850. [DOI: 10.1016/j.rmed.2022.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
|
21
|
Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, Effing TW. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 1:CD002990. [PMID: 35001366 PMCID: PMC8743569 DOI: 10.1002/14651858.cd002990.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.
Collapse
Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marlies Zwerink
- Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
22
|
Eriksen CU, Kamstrup–Larsen N, Birke H, Helding SAL, Ghith N, Andersen JS, Frølich A. Models of care for improving health-related quality of life, mental health, or mortality in persons with multimorbidity: A systematic review of randomized controlled trials. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221134017. [PMID: 36325259 PMCID: PMC9618762 DOI: 10.1177/26335565221134017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objectives To categorize and examine the effectiveness regarding health-related quality of life (HRQoL), mental health, and mortality of care models for persons with multimorbidity in primary care, community care, and hospitals through a systematic review. Methods We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials up to May 2020. One author screened titles and abstracts, and to validate, a second author screened 5% of the studies. Two authors independently extracted data and assessed risk of bias using the tool by the Cochrane Effective Practice and Organisation of Care group. Study inclusion criteria were (1) participants aged ≥ 18 years with multimorbidity; (2) referred to multimorbidity or two or more specific chronic conditions in the title or abstract; (3) randomized controlled design; and (4) HRQoL, mental health, or mortality as primary outcome measures. We used the Foundation Framework to categorize the models and the PRISMA-guideline for reporting. Results In this study, the first to report effectiveness of care models in patients with multimorbidity in hospital settings, we included 30 studies and 9,777 participants with multimorbidity. 12 studies were located in primary care, 9 in community care, and 9 in hospitals. HRQoL was reported as the primary outcome in 12 studies, mental health in 17 studies, and mortality in three studies-with significant improvements in 5, 14, and 2, respectively. The studies are presented according to settings. Conclusions Although 20 of the care models reported positive effects, the variations in populations, settings, model elements, and outcome measures made it difficult to conclude on which models and model elements were effective.
Collapse
Affiliation(s)
- Christian U Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nina Kamstrup–Larsen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Hanne Birke
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Sofie A L Helding
- Rigshospitalet and DanTrials ApS, Juliane Marie Centre, Kobenhavn, Denmark; Zero Phase 1 Unit, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nermin Ghith
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Denmark
| | - John S Andersen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Anne Frølich
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| |
Collapse
|
23
|
Copeland CR, Lancaster LH. Management of Progressive Fibrosing Interstitial Lung Diseases (PF-ILD). Front Med (Lausanne) 2021; 8:743977. [PMID: 34722582 PMCID: PMC8548364 DOI: 10.3389/fmed.2021.743977] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Progressive fibrosing interstitial lung diseases (PF-ILD) consist of a diverse group of interstitial lung diseases (ILD) characterized by a similar clinical phenotype of accelerated respiratory failure, frequent disease exacerbation and earlier mortality. Regardless of underlying disease process, PF-ILD progresses through similar mechanisms of self-sustained dysregulated cell repair, fibroblast proliferation and alveolar dysfunction that can be therapeutically targeted. Antifibrotic therapy with nintedanib or pirfenidone slow lung function decline and are the backbone of treatment for IPF with an expanded indication of PF-ILD for nintedanib. Immunosuppression is utilized for some subtypes of PF-ILD, including connective tissue disease ILD and hypersensitivity pneumonitis. Inhaled treprostinil is a novel therapy that improves exercise tolerance in individuals with PF-ILD and concomitant World Health Organization (WHO) group 3 pulmonary hypertension. Lung transplantation is the only curative therapy and can be considered in an appropriate and interested patient. Supportive care, oxygen therapy when appropriate, and treatment of comorbid conditions are important aspects of PF-ILD management. This review summarizes the current data and recommendations for management of PF-ILD.
Collapse
Affiliation(s)
- Carla R Copeland
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lisa H Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
24
|
Liang Z, Wang Q, Fu C, Liu R, Wang L, Pei G, Xu L, He C, Wei Q. What conservative interventions can improve the long-term quality of life, depression, and anxiety of individuals with stable COPD? A systematic review and meta-analysis. Qual Life Res 2021; 31:977-989. [PMID: 34383225 DOI: 10.1007/s11136-021-02965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Many conservative interventions are used in the management of stable chronic obstructive pulmonary disease (COPD). It could be helpful for the prescribers to know what the evidence suggests about the effects of these interventions on the long-term quality of life (QoL), depression, and anxiety. This study aimed to summarize the rationale for the use of conservative interventions to improve the long-term QoL, depression, and anxiety in patients with stable COPD. METHODS The MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched from database inception to December 2019. Randomized clinical trials (RCTs) investigating the long-term effects of conservative interventions on three parameters, including QoL, depression, and anxiety in patients with COPD were eligible for further analysis. To improve methodological rigor, only RCTs examining these parameters as primary outcomes were included. The standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated using random effects models. Quality of evidence was rated using the updated version of Van Tulder's criteria. RESULTS Thirty-eight RCTs were identified. Regarding long-term depression, there was moderate evidence supporting cognitive behavioral therapy compared with usual care in patients with COPD; regarding the long-term QoL of patients with COPD, there was limited evidence supporting walking programs, supplementary sugarcane bagasse dietary fiber, roflumilast, and tiotropium. CONCLUSIONS Cognitive behavioral therapy is effective in alleviating the long-term depression of patients with COPD. Evidence for other interventions was insufficient, making it difficult to draw conclusions in terms of their effectiveness on the long-term QoL, depression, and anxiety.
Collapse
Affiliation(s)
- Zejun Liang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Liu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gaiqin Pei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Xu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
25
|
Decker VB, Tofthagen C. Depression: Screening, Assessment, and Interventions in Oncology Nursing. Clin J Oncol Nurs 2021; 25:413-421. [PMID: 34269343 DOI: 10.1188/21.cjon.413-421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A high prevalence of depression exists among individuals with cancer, which negatively affects their health outcomes, quality of life, and adherence to cancer treatment. OBJECTIVES This article provides an overview and synthesis of depression screening, assessment, and nonpharmacologic treatments to help oncology nurses in their practices. METHODS Key insights are presented from a synthesized literature review regarding patients with cancer with depression. Resources for patient treatment and nurse training are also provided. FINDINGS To improve patient outcomes, nurses need to understand and follow a process that addresses the screening, assessment, and nonpharmacologic treatment of depression in patients with cancer.
Collapse
|
26
|
The complexity of mental health care for people with COPD: a qualitative study of clinicians' perspectives. NPJ Prim Care Respir Med 2021; 31:40. [PMID: 34294727 PMCID: PMC8298614 DOI: 10.1038/s41533-021-00252-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
Anxiety and depression are common mental health illnesses in people with chronic obstructive pulmonary disease (COPD). However, patients often decline formal mental health care with barriers identified at the patient, health provider and health system levels. Currently clinicians’ perspectives on this issue are not well understood. A qualitative study using semi-structured interviews was undertaken to explore clinician perceived barriers and facilitators to acceptance of psychological care amongst people with COPD. Twenty-four Australian respiratory health professionals participated. Interview transcripts were analysed thematically. An overarching theme of ‘complexity’ was identified, which was evident across five domains: (1) physical and mental health illnesses; (2) psychosocial circumstances; (3) community views and stigma; (4) educational needs and knowledge gaps; (5) navigating the health system. Targeted patient education around psychological interventions and integration of mental health clinicians within multidisciplinary outpatient respiratory services are needed to address the current challenges.
Collapse
|
27
|
Developing a complex intervention whilst considering implementation: the TANDEM (Tailored intervention for ANxiety and DEpression Management) intervention for patients with chronic obstructive pulmonary disease (COPD). Trials 2021; 22:252. [PMID: 33823935 PMCID: PMC8025339 DOI: 10.1186/s13063-021-05203-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/17/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Guidelines now call for a thorough and comprehensive description of the development of healthcare interventions to aid evaluation and understanding of the processes of change. This was the primary aim of this study but we also recognised that effective interventions are commonly not implemented in clinical practice. It is suggested that insufficient attention is given to the implementation process at the development phase of interventions. This study outlines the 5 step iterative process we adopted for considering both implementation and effectiveness issues from the outset of intervention development. We use the development of a complex intervention Tailored intervention for ANxiety and DEpression Management (TANDEM) in patients with chronic obstructive pulmonary disease to illustrate this process. METHODS Intervention development built upon the Medical Research Council framework for developing complex interventions and the person-based approach for development of behavioural interventions. Building an expert team, specifying theory, qualitative data collection and pre-piloting were all critical steps in our intervention development and are described here. RESULTS Contact with experts in the field, and explicitly building on previous work, ensured efficiency of design. Qualitative work suggested guiding principles for the intervention such as introducing mood in relation to breathlessness, and providing flexible tailoring to patients' needs, whilst implementation principles focused on training selected respiratory professionals and requiring supervision to ensure standards of care. Subsequent steps of intervention development, pre-piloting and intervention refinement led to an intervention that was deemed acceptable and if successful will be ready for implementation. CONCLUSIONS The TANDEM study was developed efficiently by building on previous work and considering implementation issues from the outset, with the aim that if shown to be effective it will have more rapid translation in to the health care system with accelerated patient benefits. TRIAL REGISTRATION ISRCTN ISRCTN59537391 . Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.
Collapse
|
28
|
Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Marshall KH, Vogiatzis I. Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients' experiences of physical activity. Respir Med 2021; 180:106353. [PMID: 33735798 DOI: 10.1016/j.rmed.2021.106353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES The Clinical PROactive Physical Activity in COPD (C-PPAC) instrument, combines a questionnaire assessing the domains of amount and difficulty of physical activity (PA) with activity monitor data (steps/day and vector magnitude units) to assess patients' experiences of PA. The C-PPAC instrument is responsive to pharmacological and non-pharmacological interventions and to changes in clinically relevant variables. We compared the effect of PA behavioural modification interventions alongside pulmonary rehabilitation (PR) to PR alone on the C-PPAC scores in COPD patients with low baseline PA levels. METHODS In this randomised controlled trial, 48 patients (means ± SD: FEV1: 50 ± 19%, baseline steps/day: 3450 ± 2342) were assigned 1:1 to receive PR alone, twice weekly for 8 weeks, or PA behavioural modification interventions (comprising motivational interviews, monitoring and feedback using a pedometer and goal setting) alongside PR (PR + PA). The C-PPAC instrument was used to assess PA experience, including a perspective of the amount and difficulty of PA. RESULTS There were clinically important improvements in favour of the PR + PA interventions compared to PR alone in: 1) the C-PPAC total score (mean [95% CI] difference: 8 [4 to 12] points, p = 0.001), the difficulty (mean [95% CI] difference: 8 [3 to 13] points, p = 0.002) and the amount (mean [95% CI] difference 8 [3 to 16] points, p = 0.005) domains and 2) the CAT score (mean [95% CI] difference: -2.1 [-3.8 to -0.3] points, p = 0.025). CONCLUSION PA behavioural modification interventions alongside PR improve the experiences of PA in patients with advanced COPD and low baseline PA levels. (NCT03749655).
Collapse
Affiliation(s)
- Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
| | - Laura McNeillie
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Francesca Chambers
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Lynsey Wakenshaw
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Graham Burns
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Karen Heslop Marshall
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
| |
Collapse
|
29
|
A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study. J Clin Med 2021; 10:jcm10040872. [PMID: 33672672 PMCID: PMC7924347 DOI: 10.3390/jcm10040872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay.
Collapse
|
30
|
Smith E, Thomas M, Calik-Kutukcu E, Torres-Sánchez I, Granados-Santiago M, Quijano-Campos JC, Sylvester K, Burtin C, Sajnic A, De Brandt J, Cruz J. ERS International Congress 2020 Virtual: highlights from the Allied Respiratory Professionals Assembly. ERJ Open Res 2021; 7:00808-2020. [PMID: 33585651 PMCID: PMC7869591 DOI: 10.1183/23120541.00808-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the European Respiratory Society International Congress 2020, which this year assumed a virtual format. The content of the sessions was mainly targeted at allied respiratory professionals, including respiratory function technologists and scientists, physiotherapists, and nurses. Short take-home messages related to spirometry and exercise testing are provided, highlighting the importance of quality control. The need for quality improvement in sleep interventions is underlined as it may enhance patient outcomes and the working capacity of healthcare services. The promising role of digital health in chronic disease management is discussed, with emphasis on the value of end-user participation in the development of these technologies. Evidence on the effectiveness of airway clearance techniques in chronic respiratory conditions is provided along with the rationale for its use and challenges to be addressed in future research. The importance of assessing, preventing and reversing frailty in respiratory patients is discussed, with a clear focus on exercise-based interventions. Research on the impact of disease-specific fear and anxiety on patient outcomes draws attention to the need for early assessment and intervention. Finally, advances in nursing care related to treatment adherence, self-management and patients' perspectives in asthma and chronic obstructive pulmonary disease are provided, highlighting the need for patient engagement and shared decision making. This highlights article provides readers with valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals.
Collapse
Affiliation(s)
- Elizabeth Smith
- Children's Lung Health, Wal-Yan Respiratory Centre, Telethon Kids Institute, Perth, Australia
- These authors contributed equally
| | - Max Thomas
- Cardiopulmonary Exercise Testing Service, University Hospitals Birmingham, Birmingham, UK
- These authors contributed equally
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- These authors contributed equally
| | - Irene Torres-Sánchez
- Dept of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- These authors contributed equally
| | - Maria Granados-Santiago
- Dept of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- These authors contributed equally
| | - Juan Carlos Quijano-Campos
- Research and Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
- These authors contributed equally
| | - Karl Sylvester
- Respiratory Physiology, Royal Papworth and Cambridge University Hospitals NHS Foundation Trusts, Cambridge, UK
| | - Chris Burtin
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreja Sajnic
- Dept for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia
| | - Jana De Brandt
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| |
Collapse
|
31
|
Britton N, Elbehairy AF, Mensink-Bout SM, Blondeel A, Liu Y, Cruz J, De Brandt J. European Respiratory Society International Congress 2020: highlights from best-abstract awardees. Breathe (Sheff) 2020; 16:200270. [PMID: 33664840 PMCID: PMC7910029 DOI: 10.1183/20734735.0270-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/24/2022] Open
Abstract
#ERSCongress 2020 best-abstract awardees summarise their virtual European Respiratory Society International Congress experience and views on the evolving field of research for their respective assembly https://bit.ly/3kJ9JrJ.
Collapse
Affiliation(s)
- Noel Britton
- Division of Pulmonary, Allergy and Critical Care Medicine, Dept of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
- These authors contributed equally
| | - Amany F. Elbehairy
- Dept of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Manchester University, Manchester, UK
- These authors contributed equally
| | - Sara M. Mensink-Bout
- Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- These authors contributed equally
| | - Astrid Blondeel
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- These authors contributed equally
| | - Yuanling Liu
- Dept of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- These authors contributed equally
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
- These authors coordinated the article
| | - Jana De Brandt
- REVAL - Rehabilitation Research Centre, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- These authors coordinated the article
| |
Collapse
|
32
|
von Leupoldt A, Brighton LJ, Peters J, Volpato E, Verkleij M, Hutchinson A, Heijmans M, Farver-Vestergaard I, Langer D, Spruit MA. ERS Scientific Working Group 09.04, “Psychologists and behavioural scientists”: the next step towards multidisciplinary respiratory care. Eur Respir J 2020; 56:56/3/2001881. [DOI: 10.1183/13993003.01881-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/18/2020] [Indexed: 12/16/2022]
|
33
|
|
34
|
Li Z, Liu Y, Wang J, Liu J, Zhang C, Liu Y. Effectiveness of cognitive behavioural therapy for perinatal depression: A systematic review and meta-analysis. J Clin Nurs 2020; 29:3170-3182. [PMID: 32563204 DOI: 10.1111/jocn.15378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/24/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To systematically review the efficacy of cognitive behavioural therapy for improving mood in perinatal depression. BACKGROUND The impact of cognitive behavioural therapy on perinatal depression has been evaluated in various studies, but there is uncertainty about their impact. DESIGN Systematic review and meta-analysis. METHODS Nine electronic literature databases were searched to retrieve eligible randomised controlled trials: CNKI, VIP digital database, Chinese Wanfang database, the Cochrane library, PubMed, Web of science, EMBASE, PsycINFO, CINAHL from the inception of the databases up to 15 November 2019. The eligible studies were screened and extracted, and then, the methodological quality was evaluated independently by two researchers. The meta-analyst software (Rev Man 5.3) was used to conduct the meta-analysis. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. RESULTS Thirteen RCTs with 966 participants were included. The results showed that the CBT group was superior to the usual care group in reducing depression symptoms of pregnant women after treatment immediately, and the difference was statistically significant. Similarly, at postpartum (<4 months), the results showed that the CBT group was superior to the usual care group in improving depression symptoms of pregnant women. However, there was no statistical difference at postpartum (>4 months). CONCLUSIONS Cognitive behavioural therapy can effectively relieve the symptoms of depression at short-term effect. However, its long-term effect need to be verified by further clinical studies. RELEVANCE TO CLINICAL PRACTICE This meta-analysis suggested that cognitive behavioural therapy should be considered as a complementary programme for patients with perinatal depression. Medical workers could apply cognitive behavioural therapy into daily routine cares for perinatal depression.
Collapse
Affiliation(s)
- Zimeng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying Liu
- Department of Cardiology, Wuxi people's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jiayao Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunmei Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
35
|
Ling C, Evans D, Zhang Y, Luo J, Hu Y, Ouyang Y, Tang J, Kuang Z. The effects of cognitive behavioural therapy on depression and quality of life in patients with maintenance haemodialysis: a systematic review. BMC Psychiatry 2020; 20:369. [PMID: 32664880 PMCID: PMC7362428 DOI: 10.1186/s12888-020-02754-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL). Although cognitive behavioural therapy (CBT) has been shown to improve depressive symptoms and QoL in other chronic illness, there is uncertainty in terms of the effectiveness of CBT in HD patients with depression or depressive symptoms. METHODS All randomised controlled trials relevant to the topic were retrieved from the following databases: CINHAL, MEDLINE, PubMed, PsycINFO and CENTRAL. The grey literature, specific journals, reference lists of included studies and trials registers website were also searched. Data was extracted or calculated from included studies that had measured depression and quality of life using valid and reliable tools -this included mean differences or standardised mean differences and 95% confidence intervals. The Cochrane risk of bias tool was used to identify the methodological quality of the included studies. RESULTS Six RCTs were included with varying methodological quality. Meta-analysis was undertaken for 3 studies that employed the CBT versus usual care. All studies showed that the depressive symptoms significantly improved after the CBT. Furthermore, CBT was more effective than usual care (MD = - 5.28, 95%CI - 7.9 to - 2.65, P = 0.37) and counselling (MD = - 2.39, 95%CI - 3.49 to - 1.29), while less effective than sertraline (MD = 2.2, 95%CI 0.43 to 3.97) in alleviating depressive symptoms. Additionally, the CBT seems to have a beneficial effect in improving QoL when compared with usual care, while no significant difference was found in QoL score when compared CBT with sertraline. CONCLUSIONS CBT may improve depressive symptoms and QoL in HD patients with comorbid depressive symptoms. However, more rigorous studies are needed in this field due to the small quantity and varied methodological quality in the identified studies.
Collapse
Affiliation(s)
- Chen Ling
- Department of Nephrology, Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800, People's Republic of China. .,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
| | - Debra Evans
- grid.19822.300000 0001 2180 2449Birmingham City University, City South Campus, Faculty of Health, Education and Life Sciences, 15 Bartholomew Row, Birmingham, B5 5JU UK
| | - Yunfang Zhang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China ,grid.284723.80000 0000 8877 7471The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jianying Luo
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yanping Hu
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yuxia Ouyang
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Jiamin Tang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Ziqiao Kuang
- grid.284723.80000 0000 8877 7471Department of Breast Surgery, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| |
Collapse
|
36
|
Soyseth TS, Dew MA, Lund MB, Haugstad GK, Soyseth V, Malt UF. Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation. Prog Transplant 2020; 30:228-234. [PMID: 32578510 DOI: 10.1177/1526924820933817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. METHODS Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. RESULTS Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. CONCLUSION Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.
Collapse
Affiliation(s)
- Torunn S Soyseth
- Department of Clinical Service, Division of Cancer Medicine, 155272Oslo University Hospital, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, 6595University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA
| | - May Brit Lund
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, 155272Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway
| | - Gro Killi Haugstad
- Department of Physiotherapy, 60499Oslo Metropolitan University, Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway
| | - Vidar Soyseth
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Department of Respiratory Diseases and Allergy, 60483Akershus University Hospital, Nordbyhagen, Norway
| | - Ulrik Fredrik Malt
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway.,Department of Research and Education, Division of Clinical Neuroscience, 155272Oslo University Hospital, Oslo, Norway
| |
Collapse
|
37
|
Wynne SC, Patel S, Barker RE, Jones SE, Walsh JA, Kon SS, Cairn J, Loebinger MR, Wilson R, Man WDC, Nolan CM. Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale. Chron Respir Dis 2020; 17:1479973120933292. [PMID: 32545998 PMCID: PMC7301664 DOI: 10.1177/1479973120933292] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depression (HADS-A ≥ 8 or/and HADS-D ≥ 8), as well as a propensity score-matched control group of patients with COPD, underwent an 8-week outpatient PR programme (two supervised sessions per week). Within- and between-group changes were calculated in response to PR. Anchor- and distribution-based methods were used to estimate the MCID. HADS-A and HADS-D improved in response to PR in both patients with bronchiectasis and those with COPD (median (25th, 75th centile)/mean (95% confidence interval) change: HADS-A change: bronchiectasis −2 (−5, 0), COPD −2 (−4, 0); p = 0.43 and HADS-D change: bronchiectasis −2 (−2 to −1), COPD −2 (−3 to −2); p = 0.16). Using 26 estimates, the MCID for HADS-A and HADS-D was −2 points. HADS-A and HADS-D are responsive to PR in patients with bronchiectasis and symptoms of mood disorder, with an MCID estimate of −2 points.
Collapse
Affiliation(s)
- Stephanie C Wynne
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah E Jones
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Samantha Sc Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Julius Cairn
- Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Robert Wilson
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| |
Collapse
|
38
|
Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
Collapse
Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| |
Collapse
|
39
|
Wijsenbeek MS, Holland AE, Swigris JJ, Renzoni EA. Comprehensive Supportive Care for Patients with Fibrosing Interstitial Lung Disease. Am J Respir Crit Care Med 2020; 200:152-159. [PMID: 31051080 DOI: 10.1164/rccm.201903-0614pp] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Marlies S Wijsenbeek
- 1 Academic Centre for Interstitial Lung Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Anne E Holland
- 2 Department of Physiotherapy, Alfred Health, Melbourne, Australia.,3 Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,4 Institute for Breathing and Sleep, Melbourne, Australia
| | - Jeffrey J Swigris
- 5 Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado; and
| | - Elisabetta A Renzoni
- 6 Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, United Kingdom
| |
Collapse
|
40
|
Sohanpal R, Pinnock H, Steed L, Heslop Marshall K, Chan C, Kelly M, Priebe S, Roberts CM, Singh S, Smuk M, Saqi-Waseem S, Healey A, Underwood M, White P, Warburton C, Taylor SJC. Tailored, psychological intervention for anxiety or depression in people with chronic obstructive pulmonary disease (COPD), TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD): protocol for a randomised controlled trial. Trials 2020; 21:18. [PMID: 31907074 PMCID: PMC6945421 DOI: 10.1186/s13063-019-3800-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are at increased risk of depression and anxiety, which greatly reduces their quality of life and is associated with worse outcomes; but these psychological co-morbidities are under-recognised and undertreated in COPD patients. Pulmonary rehabilitation (PR) improves mood for up to 6 months but health practitioners under-refer, and patients commonly fail to attend/complete PR. Research suggests that complex non-pharmacological interventions, including both psychological and exercise components, may reduce anxiety and depression in COPD. We have developed a tailored, cognitive behavioural approach (CBA) intervention for patients with COPD and co-morbid anxiety and/or depression ('TANDEM'), which precedes and optimises the benefits of currently offered PR. We hypothesise that such a psychological intervention, delivered by supervised, trained respiratory healthcare professionals, will improve mood in patients with mild to moderate anxiety and/or depression and encourage uptake and completion of PR. METHODS We will conduct a multi-centre, pragmatic, randomised controlled trial of the TANDEM intervention compared to usual care across the Midlands, London, the South East and Bristol, UK. We will train healthcare professionals familiar with COPD to deliver the manualised, tailored, face-to-face, one-to-one intervention weekly for 6-8 weeks. We will recruit 430 participants from primary, community and secondary care with confirmed COPD and moderate to very severe airflow limitation, who are eligible for assessment for PR, and who screen positive for symptoms of mild/moderate depression and/or anxiety using the Hospital Anxiety and Depression scale (HADS). Participants will be randomised 1.25:1 (intervention: usual care). The co-primary outcomes are the HADS anxiety and depression subscale scores at 6 months; participants will be followed up to 12 months. Secondary outcomes include uptake and completion of PR and healthcare resource use. There will be a parallel process evaluation and a health economic evaluation. DISCUSSION The TANDEM intervention has the potential to optimise the unrealised synergy between a psychological intervention and PR. The CBA sessions will precede PR and target individuals' cognitions, behaviours and symptoms associated with anxiety and depression to decrease psychological morbidity and increase effective self-management amongst patients with COPD. TRIAL REGISTRATION ISRCTN, ID: ISRCTN59537391. Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.
Collapse
Affiliation(s)
- Ratna Sohanpal
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Liz Steed
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Karen Heslop Marshall
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Chest Clinic, New Victoria Wing RVI Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Claire Chan
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Moira Kelly
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Stefan Priebe
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - C. Michael Roberts
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Sally Singh
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP UK
| | - Melanie Smuk
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Sarah Saqi-Waseem
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Andy Healey
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Martin Underwood
- Warwick CTU, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL and University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Patrick White
- School of Population Health and Environmental Sciences, King’s College London, Great Maze Pond, London, SE1 1UL UK
| | | | - Stephanie J. C. Taylor
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - On behalf of the TANDEM Investigators
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Chest Clinic, New Victoria Wing RVI Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP UK
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- Warwick CTU, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL and University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
- School of Population Health and Environmental Sciences, King’s College London, Great Maze Pond, London, SE1 1UL UK
- London, UK
| |
Collapse
|
41
|
Oleynick C. Recurrent episodes of hypercapnic respiratory failure triggered by panic attacks in a patient with chronic obstructive pulmonary disease. Respir Med Case Rep 2020; 30:101044. [PMID: 32257794 PMCID: PMC7118310 DOI: 10.1016/j.rmcr.2020.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/27/2022] Open
Abstract
A 67-year old female with moderate chronic obstructive pulmonary disease (COPD) and generalized anxiety disorder presents with three episodes of severe hypercapnic respiratory failure over the previous three months without a clear precipitant that were treated with invasive and non-invasive ventilation. These episodes were labelled as acute exacerbations of COPD, however she lacked any typical features or triggers and responded faster than expected to treatment and she underwent extensive investigations to identify an alternative etiology. While admitted and under observation, she became extremely anxious, began to hyperventilate and went into hypercapnic respiratory failure, which was successfully aborted with sublingual lorazepam causing resolution of tachypnea. It became clear that the patient was suffering from panic attacks as the precipitant for her respiratory failure and she was successfully treated with psychiatric medication and breakthrough anxiolytics. Anxiety and panic disorders are more prevalent in patients with COPD than the general population and effective management is important as patient's with anxiety and COPD have worse clinical outcomes than with COPD alone. Additionally, panic attacks should be considered as an etiology for hypercapnic respiratory failure in patients with COPD and anxiety when the clinical presentation is atypical.
Collapse
|
42
|
Whelan ME, Velardo C, Rutter H, Tarassenko L, Farmer AJ. Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e14946. [PMID: 31755872 PMCID: PMC6898889 DOI: 10.2196/14946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/11/2019] [Accepted: 08/31/2019] [Indexed: 01/23/2023] Open
Abstract
Background Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. Objective We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. Methods A total of 107 men and women with a clinical diagnosis of COPD, aged ≥40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ≥5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. Results Overall, 94 (87.9%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ≥2 responses each month. Of all the participants, 47 (50%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7%) began after being signposted. Participants signposted to the stress management video (100%; IQR 23.3-100%) watched a greater proportion of it compared to those not signposted (38.4%; IQR 16.0-68.1%; P=.03), whereas duration of viewing was not significantly different for the mood management video. Conclusions Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD.
Collapse
Affiliation(s)
- Maxine E Whelan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Heather Rutter
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
43
|
Ma RC, Yin YY, Wang YQ, Liu X, Xie J. Effectiveness of cognitive behavioural therapy for chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 38:101071. [PMID: 31743870 DOI: 10.1016/j.ctcp.2019.101071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND and purpose: Cognitive behavioural therapy (CBT) has gained increasing attention for the treatment of psychological disorders. This study aims to establish the effectiveness of CBT on psychological and physical outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS Two waves of electronic searches of the PubMed, Cochrane library, EMBASE, Web of Science and China National Knowledge Infrastructure databases were conducted. Statistical analyses were performed using Revman Manager 5.3 and Stata 12.0 software. RESULTS Sixteen randomized controlled trials were eligible. There were significant improvements in anxiety (SMD = -0.23; 95% CI: -0.42 to -0.04; P = 0.02), depression (SMD = -0.29, 95% CI: -0.40 to -0.19, P < 0.01), quality of life (MD = -5.21; 95% CI: -10.25 to -0.17; P = 0.04), and mean visits to emergency departments in the CBT groups. No statistically significant differences were observed in fatigue (SMD = 0.88, 95% CI: -0.58 to 2.35, P = 0.24), exercise capacity (MD = 28.75, 95% CI: -28.30 to 85.80, P = 0.32), self-efficacy (SMD = 0.15, 95% CI: -0.05 to 0.34, P = 0.14), or sleep quality (MD = 1.21, 95% CI: -0.65 to 3.06, P = 0.20). CONCLUSION This meta-analysis suggests that CBT can serve as a complementary therapy to improve anxiety, depression, and quality of life in COPD patients and deserves more widespread application in clinical practice.
Collapse
Affiliation(s)
- Rui-Chen Ma
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Xin Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Jiao Xie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| |
Collapse
|
44
|
Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
Collapse
|
45
|
A Qualitative Study to Inform a More Acceptable Pulmonary Rehabilitation Program after Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2019; 16:1158-1164. [DOI: 10.1513/annalsats.201812-854oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
46
|
Heslop-Marshall K, Burns G. The role of cognitive behavioural therapy in living well with COPD. Breathe (Sheff) 2019; 15:95-97. [PMID: 31191716 PMCID: PMC6544791 DOI: 10.1183/20734735.0119-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Psychological ill health is very common in COPD; CBT may be a key step towards improving the care of COPD patients http://ow.ly/fb8j30onfPj.
Collapse
Affiliation(s)
- Karen Heslop-Marshall
- Dept of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Health and Society, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Graham Burns
- Dept of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
47
|
Yohannes AM. Nurse-led cognitive behavioural therapy for treatment of anxiety in COPD. ERJ Open Res 2018; 4:00221-2018. [PMID: 30568966 PMCID: PMC6293040 DOI: 10.1183/23120541.00221-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 02/01/2023] Open
Abstract
Anxiety disorders are common and debilitating conditions that significantly impair the physical functioning and quality of life (QoL) of patients with chronic obstructive pulmonary disease (COPD). A recent systematic review identified the high prevalence of these disorders in patients with COPD, ranging 6–33% for generalised anxiety, 0–44% for panic disorder, 10–27% for specific phobias, and 5–11% for social phobias [1]. Furthermore, under-recognised or untreated anxiety disorders in COPD patients may reduce the QoL of their caregivers and increase emergency care visits and hospital admissions [1–5]. In 2004, in the European Union, the estimated direct (e.g. hospital admissions and medications) and indirect (e.g. loss of productivity due to absence from work) cost of anxiety disorders exceeded €41 billion per annum [2]. Nurse-led cognitive behavioural therapy is feasible and cost-effective for the treatment of anxiety in patients with chronic obstructive pulmonary disease.http://ow.ly/QZJT30mJdXU
Collapse
Affiliation(s)
- Abebaw Mengistu Yohannes
- School of Behavioral and Applied Sciences, Dept of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| |
Collapse
|