Cognitive-behavioral therapy (CBT) performed by ventilators is cost effective and reduces anxiety symptoms in patients with chronic obstructive pulmonary disease (COPD) ERJ Open Research,

COPD is a long-term disease that causes inflammation in the lungs, narrowing of the respiratory tract and damaged lung tissue and makes breathing difficult. Anxiety often occurs alongside COPD and may cause patients to exercise less, resulting in a loss of fitness, isolation, and overall deterioration of health. The new study found that short CBT sessions with ventilators reduced the feeling of anxiety in patients with COPD and led to less frequent use of A & E and hospital services.

Dr. Karen Heslop-Marshall, Nurse Consultant at the Newcastle-upon-Tyne NHS Foundation Trust and Newcastle University, UK, was senior investigator of the study. She explains: "One of the main symptoms of COPD is shortness of breath, which is very scary and often leads to feelings of anxiety." Many health professionals are not currently evaluating COPD patients for anxiety symptoms, although this may affect their entire body health.

"Anxiety has a negative impact on the quality of life of patients and leads to increased use of health resources, and we wanted to test whether CBT sessions conducted by respiratory physicians could alleviate the symptoms of anxiety in a personal conversation and whether this could be a cost-effective problem Intervention. "

A total of 236 patients were diagnosed with mild to very severe COPD in the study.

Each patient was also tested for anxiety with the HADS-Anxiety Subscale. This is a simple questionnaire that asks patients about their anxiety and depression during the last week. Values ​​between eight and ten show mild symptoms, 11-14 show moderate symptoms, and more than 15 results indicate severe symptoms.

All patients who participated in the study scored eight or more on the HADS scale. Overall, 59% of the HADS scores screened for entry into the study had increased, suggesting that COPD anxiety is very common.

Over a period of three months, patients were given either leaflets to treat anxiety or leaflets, as well as CBT. In the CBT sessions, patients were trained in how coping strategies can be developed to deal with the states of respiratory distress and improve physical activity.

All patients received standard medical care, including pulmonary function tests, medical review, and appropriate medical treatments. If eligible, they also received pulmonary rehabilitation, a supervised exercise program for COPD patients.

After three months, patients re-filled out the HADS anxiety questionnaire to see how the various treatments had an effect on their state of anxiety.

The researchers found that CBT is more effective in reducing anxiety symptoms in COPD patients than in pamphlets alone; On average, the results of the HADS anxiety scale of CBT patients improved by 3.4, while patients in the leaflet group improved by only 1.9.

After reviewing the patients' sick leave visits in the study, the researchers found that for every patient who participated in CBT, an average saving of £ 1,089 for hospital admissions and £ 63 for emergency department emergency rooms was achieved.

The data also showed no relationship between a patient's lung function, as measured by how much air a person can exhale in one second and their level of anxiety. The researchers say that this suggests that even patients with mild COPD may be extremely anxious and benefit from this intervention.

Dr. Heslop-Marshall said, "We found that one-to-one CBT sessions performed by ventilators could reduce the symptoms of anxiety, and that this could be a cost-effective intervention, although CBT intervention initially entails additional costs Training as a ventilator Training in CBT skills has been offset by the savings made by the less frequent need for hospital and A & E services.

"Reducing patient anxiety has a significant impact on their quality of life, as well as their ability to stay physically active, and can improve survival in the long term, and our research shows that front-line ventilators can perform this intervention efficiently and effectively."

Researchers say it is not possible to blind participants in the treatment they received, which may have affected their responses to the second HADS questionnaire. They are also unable to determine which specific element of the CBT intervention, e.g. For example, coping strategies to manage frightening thoughts, stimulation, breathing control, distraction, or encouraging physical activity have been the most effective in reducing anxiety.

Dr. Thierry Troosters of the Katholieke Universiteit Leuven, Belgium, is the designated President of the European Respiratory Society and is not involved in the research. He said, "COPD is a major burden on individuals, societies and health systems around the world, in part because of ongoing exposure to COPD, such as smoking and air pollution, and partly due to the aging population.

"This research shows how using a multidisciplinary approach in the treatment of COPD can reduce the burden on patients and healthcare services.Treating patients with concomitant conditions such as anxiety contributes significantly to improving overall health, and these methods can be cost effective The care provided by dedicated and well educated health professionals also allows the early referral of patients with serious mental illnesses to even more specialized care lines. "

Source:

http://www.europeanlung.org/de/

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