A study has found that patients with COPD who have certain characteristics appear to be at the highest risk of physical and mental distress.


 

Published studies have shown that COPD-related breathing exacerbations can increase risks for physical immobility and emotional distress. “Identifying modifiable behavioral and environmental factors that contribute to physical and emotional distress in patients with COPD is a fundamental goal of effective disease management,” says Michael Stellefson, PhD, MCHES. “However, there is limited evidence on how behavioral risk factors like smoking and vaccine avoidance contribute to physical and mental distress in people with COPD. Furthermore, relatively few studies have documented associations between access-to-care and quality of life in these patients.”

The Behavioral Risk Factor Surveillance System (BRFSS), operated by the CDC, is the nation’s premier system of health-related telephone surveys that collect data about Americans regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. For a study published in the International Journal of COPD, Dr. Stellefson and colleagues conducted a secondary analysis of existing BRFSS data to identify subgroups of adults with COPD at highest risk for physical and mental distress.

“Specifically, our analysis sought to identify subgroups of patients with COPD who had high probabilities of risky behaviors and were living with multiple comorbidities,” adds Dr. Stellefson. “We believe this research is important because identifying high-risk patient segments can help clinicians in their efforts to personalize treatments for patients with COPD, especially those reporting poor quality of life.”

 

Analyzing Key Findings

According to the study results, more than half of BRFSS respondents with a COPD diagnosis experienced physical and/or mental distress in the past 14 days. Factors associated with mental and physical distress included female gender, aged 45-64 years, and having a lower socioeconomic status. “In addition, many patients with COPD were classified as engaging in risk behaviors, such as smoking and alcohol consumption,” says Dr. Stellefson. About one-third of patients with COPD had multiple comorbidities.

While most respondents had access to healthcare, less than half in the highest risk class reported having a healthcare plan. With regard to vaccinations, only about 25% of respondents in the highest risk class reported getting their annual flu shot, while slightly more than 20% reported being vaccinated against pneumonia.

Overall, adults with a diagnosis of COPD who responded to the BRFSS were more likely to report frequent physical distress if they had intermediate- to high-risk behaviors, intermediate to multiple comorbidities, limited access to healthcare, and intermediate to low use of preventive vaccinations when compared with those categorized as low-risk respondents (Table). Similarly, respondents with high-risk behaviors, intermediate to multiple comorbidities, and low use of preventive vaccinations were more likely to report frequent mental distress than the low-risk group.

Interestingly, limited access to healthcare was not significantly associated with frequent mental distress. “Having access to health insurance and healthcare may have less bearing on the extent to which mental health problems like depression and anxiety occur in patients with COPD,” Dr. Stellefson says.

 

Assessing Implications

In light of the findings, Dr. Stellefson says clinicians should develop individualized treatment plans to help patients manage unique symptoms of physical distress, such as shortness of breath, fatigue, congestion, and wheezing. “Clinicians should also aim to reduce psychosocial stress by recommending emotional coping mechanisms, such as meditation, visual imagery, and muscle relaxation,” he says. “It’s also important to monitor and address biopsychosocial elements of substance use and mental health treatments in the context of COPD management. To slow disease progression, high-risk patients should be reminded to schedule an annual physical to closely monitor changes in lung functioning as well as mental health.”

Despite widespread efforts to promote annual flu vaccines for patients with COPD, too few patients are being vaccinated. “Low vaccination rates are concerning because people with COPD are particularly vulnerable to influenza, which can cause breathing exacerbations and pneumonia,” says Dr. Stellefson. “This can result in significant healthcare burden and even premature death. To improve these low rates, clinicians should strongly advocate for vaccinations when communicating with patients who have COPD and their informal caregivers.”

References

Stellefson M, Paige SR, Barry AE, Wang MQ, Apperson A. Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. Int J Chron Obstruct Pulmon Dis. 2019;14:809-822. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462160/.

Tselebis A, Pachi A, Ilias I, et al. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatr Dis Treat. 2016;12:297-328.

Hsu DJ, North CM, Brode SK, Celli BR. Identification of barriers to influenza vaccination in patients with chronic obstructive pulmonary disease: analysis of the 2012 Behavioral Risk Factors Surveillance System. Chronic Obstr Pulm Dis. 2016;3(3):620-627.