Evidence shows that COPD is an increasingly important public health problem with increased rates of morbidity and mortality among those with the disease, when compared with the general population. “Patients with COPD tend to have a lower quality of life (QOL) due to their disease-related symptoms,” says Michael Durheim, MD. “They also commonly have various psychological comorbidities on top of the pulmonary-related impacts on their functional status.”
A Phone-Based Intervention
Novel interventions are needed to improve outcomes for patients with COPD. In a study published in Psychosomatic Medicine, known as INSPIRE-II, Dr. Durheim and colleagues assessed the effects of a telephone-based intervention involving training patients in coping skills to see if such training improves psychological and somatic QOL. The study also assessed whether the intervention could decrease the risk of COPD-related hospitalizations or all-cause mortality in patients with moderate-to-severe COPD.
For the study, patients were randomized to 16 weeks of COPD education or the telephone intervention, which was originally designed to help individuals address anxiety and depression that may be associated with pulmonary disease. Participants completed numerous QOL instruments, pulmonary function tests, and functional measures and were then followed-up for as long as 4.4 years to assess outcomes.
According to the results, the coping skills intervention did not result in reduced risk of COPD-related hospitalizations or death from any cause. “However, patients who received the intervention had improvements in their psychological and somatic QOL,” Dr. Durheim says. This included improvements in depression and anxiety scores and general measures of quality of life.
Greater improvements were also seen in pulmonary QOL for the intervention. This included less fatigue and shortness of breath as well as greater improvements in walking test distances.
“Our findings suggest that there are behavioral interventions that can improve QOL outcomes in patients with COPD,” says Dr. Durheim. The findings also highlight the importance of assessing the additional aspects of COPD that may not be routinely measured or assessed by pulmonologists. He adds that clinicians should consider whether behavioral interventions could be utilized to address these factors.
It is still undetermined if improving QOL or psychological comorbidities of COPD through an intervention like the one used in the study can improve risk for hospitalization or death. “Other interventions tested in future research may improve QOL and also reduce hospitalization and mortality risks,” Dr. Durheim says. “It’s possible that the COPD education received by the control group in INSPIRE-II may be been beneficial over and above their usual care. Teaching patients about their disease may have improved their medical outcomes, but more research is needed to explore this possibility and other outstanding questions.”
Readings & Resources (click to view)
Blumenthal J, Emery C, Smith P, et al. The effects of a telehealth coping skills intervention on outcomes in chronic obstructive pulmonary disease: primary results from the INSPIRE-II study. Psychosom Med. 2014;76:581-592. Available at http://journals.lww.com/psychosomaticmedicine/Citation/2014/10000/The_Effects_of_a_Telehealth_Coping_Skills.3.aspx.
Farver-Vestergaard I, Jacobsen D, Zachariae R. Efficacy of psychosocial interventions on psychological and physical health outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Psychother Psychosom. 2014;84:37-50.
Pumar M, Gray C, Walsh J, et al. Anxiety and depression-important psychological comorbidities of COPD. J Thorac Dis. 2014;6:1615-1631.
Lee H, Yoon J, Lim Y, et al. The effect of nurse-led problem-solving therapy on coping, self-efficacy and depressive symptoms for patients with chronic obstructive pulmonary disease: a randomised controlled trial. Age Ageing. 2014 Dec 29. [Epub ahead of print]. Available at http://ageing.oxfordjournals.org/content/early/2014/12/29/ageing.afu201.abstract.