The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability

Abstract

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPDrelated fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Structural Brain Changes in Patients With COPD

“…39,40 Increased fear of dyspnea due to lower ACC functionality might further fuel this vicious circle and lead to even more fear and avoidance of physical activity, subsequent deconditioning, increased dyspnea, and greater reductions in health-related quality of life. 5,6 Addressing these disease-specific fears seems, therefore, highly important in the treatment of COPD. 5,6 In this regard, it would be interesting to examine whether the treatment of dyspnea and disease-specific fears can stop or even reverse GMV reductions in patients with COPD.…”

“…5,6 Addressing these disease-specific fears seems, therefore, highly important in the treatment of COPD. 5,6 In this regard, it would be interesting to examine whether the treatment of dyspnea and disease-specific fears can stop or even reverse GMV reductions in patients with COPD. Previous findings in chronic pain patients demonstrated that pain-related gray matter changes are not static and at least partially reversible after successful treatment of pain.…”

“…3 Not surprisingly, COPD is often accompanied by high levels of comorbid anxiety and depression. 4 In particular, disease-specific fears, like fear of dyspnea and fear of physical activity, contribute to disability in COPD and have been suggested to fuel a downward spiral of avoidance of physical activity, 5 subsequent deconditioning, and greater dyspnea at even lower activity levels resulting in significant reductions in health-related quality of life. 2,[6][7][8] Unfortunately, little is known about underlying brain processes in COPD.…”

Bedeutung von Depression und Angst im Krankheitsmanagement von pneumologischen Berufskrankheiten

“…Schließlich berichten COPD-Patienten über krankheitsspezifische Ängste wie Angst vor Atemnot, vor körperlicher Aktivität oder sozialer Ausgrenzung [23].…”

“…Weiterhin ist nachweisbar, dass Depressionen mit einem höheren Risiko für häufigere Exazerbationen und Krankenhausaufenthalte verbunden sind [43]. Schließlich beeinflussen COPDspezifische Ängste zum einen die wahrgenommenen Einschränkungen durch die Erkrankung [23], zum anderen mediieren jene die Beziehung zwischen psychischen Belastungen und End-of-lifeÄngsten [46].…”