Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

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.

Keywords: COPD; anxiety; disease-specific fears; pulmonary rehabilitation.

Figure 1

Individual trajectories of dyspnea-related fears with mean trajectories (±95% CI) superimposed.

Figure 2

Individual trajectories of COPD assessment test (CAT) scores for participants with different levels of disease-specific fears (color indicates level of disease-specific fear). Estimated trajectories for participants with disease-specific fear scores 1SD above mean, mean, and 1SD below mean (95% CI) are superimposed. (Panel a): Fear of Dyspnea (FD), (Panel b): Fear of Physical Activity (FPA), (Panel c): Fear of Progression (FPR), (Panel d): Fear of Social Exclusion (FSE), (Panel e): Sleep-Related Worries (SRW).

Figure 3

Individual trajectories of St. Georges respiratory questionnaire (SGRQ) activity scores for participants with different levels of disease-specific fears (color indicates level of disease-specific fear). Estimated trajectories for participants with disease-specific fear scores 1SD above mean, mean, and 1SD below mean (95% CI) are superimposed. (Panel a): Fear of Dyspnea (FD), (Panel b): Fear of Physical Activity (FPA), (Panel c): Fear of Progression (FPR), (Panel d): Fear of Social Exclusion (FSE), (Panel e): Sleep-Related Worries (SRW).

Figure 4

Associations between individual changes in disease-specific fears and COPD assessment test scores for participants with different levels of disease-specific fears (color indicates mean level of disease-specific fear). Estimated associations for participants with disease-specific fear scores 1SD above mean, mean, and 1SD below mean (95% CI) are superimposed. (Panel a): Fear of Dyspnea (FD), (Panel b): Fear of Physical Activity (FPA), (Panel c): Fear of Progression (FPR), (Panel d): Fear of Social Exclusion (FSE), (Panel e): Sleep-Related Worries (SRW).

Figure 4

Associations between individual changes in disease-specific fears and COPD assessment test scores for participants with different levels of disease-specific fears (color indicates mean level of disease-specific fear). Estimated associations for participants with disease-specific fear scores 1SD above mean, mean, and 1SD below mean (95% CI) are superimposed. (Panel a): Fear of Dyspnea (FD), (Panel b): Fear of Physical Activity (FPA), (Panel c): Fear of Progression (FPR), (Panel d): Fear of Social Exclusion (FSE), (Panel e): Sleep-Related Worries (SRW).