Karin Taube

The Impact of Anxiety and Depression on Outcomes of Pulmonary Rehabilitation in Patients With COPD

BACKGROUND Anxiety and depression are prevalent comorbidities in COPD and are related to a worse course of disease. The present study examined the impact of anxiety and depression on functional performance, dyspnea, and quality of life (QoL) in patients with COPD at the start and end of an outpatient pulmonary rehabilitation (PR) program. METHODS Before and after PR, 238 patients with COPD (mean FEV(1) % predicted = 54, mean age = 62 years) underwent a 6-min walking test (6MWT). In addition, anxiety, depression, QoL, and dyspnea at rest, after the 6MWT, and during activities were measured. RESULTS Except for dyspnea at rest, improvements were observed in all outcome measures after PR. Multiple regression analyses showed that before and after PR, anxiety and depression were significantly associated with greater dyspnea after the 6MWT and during activities and with reduced QoL, even after controlling for the effects of age, sex, lung function, and smoking status. Moreover, before and after PR, anxiety was related to greater dyspnea at rest, whereas depression was significantly associated with reduced functional performance in the 6MWT. CONCLUSIONS This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR. The results underline the clinical importance of detecting and treating anxiety and depression in patients with COPD.

The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease

Dyspnea is the cardinal symptom of chronic obstructive pulmonary disease (COPD). Affective states can profoundly impact upon the perception of dyspnea, but little is known about this relationship in patients with COPD. We, therefore, examined the impact of viewing positive versus negative affective picture series on perceived dyspnea during two cycle ergometer exercise tests (CEET) in 30 patients with COPD. Whereas cardiopulmonary measures indicated comparable exercise intensity during both CEETs, parallel viewing of negative affective pictures resulted in increased dyspnea ratings compared to positive affective pictures. Regression analyses showed that only during positive picture viewing increases in the affective unpleasantness of dyspnea, but not in the sensory intensity of dyspnea, during CEETs were predictive of greater dyspnea during everyday activities and reduced health-related quality of life. The results suggest that negative affective states increase perceived dyspnea in patients with COPD and underline the importance of targeting the affect-dyspnea-relationship in this patient group.

Social comparison and anxious mood in pulmonary rehabilitation: the role of cognitive focus.

OBJECTIVES   Comorbid anxiety is highly prevalent in Chronic Obstructive Pulmonary Disease (COPD), and it is related to increased morbidity and mortality. It has consistently been found that social comparison has substantial impact on mood. However, despite the strong social component of pulmonary rehabilitation, the effect of social comparison processes on anxiety has not been explored in this context. DESIGN   Participants were 43 COPD patients enrolled in a 3-week pulmonary rehabilitation programme. We tested in a longitudinal design the relationship between social comparison and assimilation and contrast at the beginning of rehabilitation and anxious mood at the end of the programme. METHODS   Using moderator analysis, we tested whether perceived similarities and differences to upward and downward social comparison standards influence the relationship between comparison direction at the beginning of the programme and anxious mood at the end of the programme. RESULTS   The relationship between social comparison at the start of rehabilitation and anxious mood at the end of the programme was dependent on assimilation and contrast to upward and downward standards. Downward assimilation and upward contrast were related to a stronger relationship of upward and downward social comparison and anxious mood. CONCLUSION   This study demonstrates the important role of social comparison focus in moderating beneficial effects of pulmonary rehabilitation. Downward assimilation and upward contrast might be important targets in reducing anxiety in pulmonary rehabilitation.

Brain Activation during Perception and Anticipation of Dyspnea in Chronic Obstructive Pulmonary Disease

Background: Dyspnea is the impairing cardinal symptom in COPD, but the underlying brain mechanisms and their relationships to clinical patient characteristics are widely unknown. This study compared neural responses to the perception and anticipation of dyspnea between patients with stable moderate-to-severe COPD and healthy controls. Moreover, associations between COPD-specific brain activation and clinical patient characteristics were examined. Methods: During functional magnetic resonance imaging, dyspnea was induced in patients with stable moderate-to-severe COPD (n = 17) and healthy control subjects (n = 21) by resistive-loaded breathing. Blocks of severe and mild dyspnea were alternating, with each block being preceded by visually cued anticipation phases. Results: During the perception of increased dyspnea, both patients and controls showed comparable brain activation in common dyspnea-relevant sensorimotor and cortico-limbic brain regions. During the anticipation of increased dyspnea, patients showed higher activation in hippocampus and amygdala than controls which was significantly correlated with reduced exercise capacity, reduced health-related quality of life, and higher levels of dyspnea and anxiety. Conclusions: This study suggests that patients with stable moderate-to-severe COPD show higher activation in emotion-related brain areas than healthy controls during the anticipation, but not during the actual perception of experimentally induced dyspnea. These brain activations were related to important clinical characteristics and might contribute to an unfavorable course of the disease via maladaptive psychological and behavioral mechanisms.

Recommendations by the German Airway League for sports and physical exercise in patients with obstructive lung disease

nem Anstieg der Sauerstoffaufnahme, des Sauerstoffpulses und einer Verschiebung der anaeroben Schwelle zu höherer Belastungsintensität. Im Verlauf des Trainingsprogramms nehmen bei einer definierten Belastung die Lactatkonzentration im Blut und die Ventilation ab. Die Kenngrößen der Lungenfunktion unter Ruhebedingungen verändern sich hingegen allenfalls geringfügig. Ein wesentlicher Effekt des Trainings ist die Abnahme der Belastungsdyspnoe [6, 7], die eine zentrale Bedeutung für die Lebensqualität der Patienten hat. Für den Aufbau und die Steigerung der körperlichen Leistungsfähigkeit bei Gesunden wird international eine Belastung von mindestens 20 Minuten mit einer Pulsfrequenz von anfangs 50%, nach zwei bis drei Wochen mindestens 75% des WHO-Sollwertes in einer Häufigkeit von mindestens dreimal pro Woche empfohlen [10, 20]. Ob diese Empfehlung auch für ambulante Sportgruppen von Asthmatikern Gültigkeit hat, ist bisher nicht geklärt. Es ist allerdings nachgewiesen, daß bei Patienten mit geringer Kondition auch ein einmal pro Woche durchgeführtes Training bei der empfohlenen Herzfrequenz langfristig zu einer Steigerung der Leistungsfähigkeit führen kann [21, 23]. Dabei spielt auch der Signaleffekt des Trainings bezüglich einer gesunden Lebensführung eine Rolle [11]. Der langsamere Aufbau der Kondition hat zudem den Vorteil, daß eine höhere Trainingsfestigkeit erreicht wird und damit größere Aussichten auf die Erhaltung der körperlichen Leistungsfähigkeit und die Integration des Sportes in das Alltagsleben eines chronisch Kranken bestehen. Die kindliche Entwicklung wird auch durch die körperliche Leistungsfähigkeit geprägt. So fühlen sich Kinder in erster Linie dann behindert, wenn sie beim Sport und Spiel mit Gleichaltrigen nicht mithalten können. Diese Entwicklung wird durch NegativerlebEmpfehlungen der Deutschen Atemwegsliga zum Sport und körperlichen Training bei Patienten mit obstruktiven Atemwegserkrankungen