Disease-specific fears impact outcomes of pulmonary rehabilitation in patients with COPD

Background:

Recent studies demonstrated that anxiety is highly prevalent in patients with COPD and has negative effects on their pulmonary rehabilitation (PR) outcomes. More recently, the relevance of disease-specific fears in COPD has been suggested. However, disease-specific fear is a multifaceted concept and little is still known about how its components relate to outcomes of PR. Therefore, the present study tested how different disease-specific fears relate to different outcomes of PR in patients with COPD.

Methods:

Before and after a 3-week inpatient PR program, patients with COPD underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears were assessed with the COPD-Anxiety-Questionnaire and Fear Avoidance Questionnaire COPD. In addition, health-related quality of life (QoL), general anxiety, depression, activity-related dyspnea, and dyspnea-related disability were assessed using validated questionnaires.

Results:

Multiple regression analyses showed that at the start of PR, higher levels of fear of physical activity, fear of dyspnea, fear of disease progression, fear-avoidance behavior, and fear-avoidance beliefs were associated with worse functional exercise capacity, physical QoL, activity-related dyspnea, and dyspnea-related disability, even after controlling for potential confounding effects of age, sex, lung function, smoking status, and general anxiety. Moreover, greater disease-specific fears at the start of PR predicted more unfavorable levels in these outcomes at the end of PR.

Discussion:

The results show that disease-specific fears negatively impact PR outcomes in COPD patients beyond the effects of general anxiety. Different disease-specific fears, therefore, should be diagnosed and treated in order to improve effects of PR in patients with COPD.