Psychosocial Interventions for Patients with Severe COPD-An Up-to-Date Literature Review

Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.

Effectiveness of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Therapy: Focusing on Traditional Medical Practices

Chronic obstructive pulmonary disease (COPD) is a complex and serious disease that is characterized by dyspnea, fatigue, decreased exercise tolerance, peripheral muscle dysfunction, and mood disorders. These manifestations are successfully treated with pulmonary rehabilitation, a comprehensive intervention and holistic approach designed to improve the physical and psychological condition of people with COPD. Exercise is a big component of pulmonary rehabilitation programs, but the efficacy of non-traditional forms of exercise as used in alternative medicine is poorly understood. Here, we aim to address this gap in knowledge and summarize the clinical evidence for the use of traditional exercise regimens in the pulmonary rehabilitation of COPD patients.

Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications

BACKGROUND

Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society.

OBJECTIVE

The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management.

METHODS

From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression.

RESULTS

Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P< 0.05). Interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were significantly higher in the COPD with depression group than in the group without depression (P< 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6 months was noticeably higher in the COPD with depression group than in the group without depression.

CONCLUSION

Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD.

Psychosocial Intervention in Chronic Obstructive Pulmonary Disease: Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Many patients with chronic obstructive pulmonary disease (COPD) experience persistent interrelated psychological and physical symptoms despite optimal treatment. Several studies of psychosocial intervention in COPD have been published in recent years. The present study aimed to conduct a quantitative summary of the efficacy of such interventions on psychological and physical outcomes.

METHODS

Two independent raters screened PubMed, PsycINFO, Embase, Web of Science, Cochrane Library, and CINAHL for eligible studies. In all, 35 independent, randomized controlled trials with a total of 3,120 patients with COPD were included, assessed for their methodological quality, and subjected to meta-analytic evaluation.

RESULTS

Meta-analyses revealed small, statistically significant effects of psychosocial intervention on combined psychological (Hedges's g = 0.28; 95%CI: 0.16-0.41) and physical outcomes (g = 0.21; 95%CI: 0.07-0.35) with no indications of publication bias. Supplementary Bayesian meta-analyses provided strong evidence for a non-zero overall effect on psychological outcomes (Bayes factor (BF) = 305) and moderate support for physical outcomes (BF = 6.1). Exploring sources of heterogeneity with meta-regression indicated that older age of patients and longer duration of interventions were associated with smaller effects on psychological outcomes.

CONCLUSIONS

The results support psychosocial intervention as an additional, useful tool in multidisciplinary respiratory care with the potential to improve both psychological and physical outcomes. Future studies are recommended to monitor adverse effects, apply blinding of active control conditions, and determine sample sizes with a priori power calculations.

REGISTRATION

Registered with Prospero (www.crd.york.ac.uk/prospero/) prior to initiation of the literature search (Reg. ID: CRD42020170083).

Diagnostic and therapeutic challenges of chronic obstructive pulmonary disease in the elderly

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) imposes a large burden on the global population and even more so for the elderly who face significant obstacles in the diagnosis, management, and psychosocial effects of the disease. This review describes the current challenges and key points in the management of COPD in the elderly.

RECENT FINDINGS

Lower limit rather than fixed cut off of the FEV1/FVC ratio can improve the diagnosis and better predict COPD mortality. High relative to standard dose influenza vaccination reduces confirmed cases of influenza overall and reduces hospitalizations in older nursing home residents. Simple interventions that include electronic health record tracking can significantly improve vaccination rates. Although many inhaler and nebulized medications are available for the elderly, the final regimen is usually determined by a combination of expense, issues with proper device use (from difficulty with coordination, hand grip, inspiratory flows or cognitive function) and the side effect profile. Fortunately, the switch to cheaper or better covered alternatives can be well tolerated with improvement in adherence and exacerbations of COPD. Finally, caution should be made against ageism, which may be a factor in the recommendation of rehabilitation or palliative care in the elderly COPD patient, as both are underused despite evidence of benefit.

SUMMARY

Although care for the elderly COPD patient can be difficult, we summarize key points that the physician should be cognizant of to provide comprehensive care.

Telemedicine in COPD: An Overview by Topics

COPD is a major cause of morbidity and mortality worldwide and carries a huge and growing economic and social burden. Telemedicine might allow the care of patients with limited access to health services and improve their self-management. During the COVID-19 pandemic, patient's safety represents one of the main reasons why we might use these tools to manage our patients. The authors conducted a literature search in MEDLINE database. The retrieval form of the Medical Subject Headings (Mesh) was ((Telemedicine OR Tele-rehabilitation OR Telemonitoring OR mHealth OR Ehealth OR Telehealth) AND COPD). We only included systematic reviews, reviews, meta-analysis, clinical trials and randomized-control trials, in the English language, with the selected search items in title or abstract, and published from January 1st 2015 to 31st May 2020 (n = 56). There was a positive tendency toward benefits in tele-rehabilitation, health-education and self-management, early detection of COPD exacerbations, psychosocial support and smoking cessation, but the heterogeneity of clinical trials and reviews limits the extent to which this value can be understood. Telemonitoring interventions and cost-effectiveness had contradictory results. The literature on teleconsultation was scarce during this period. The non-inferiority tendency of telemedicine programmes comparing to conventional COPD management seems an opportunity to deliver quality healthcare to COPD patients, with a guarantee of patient's safety, especially during the COVID-19 outbreak.

Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process

Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.