Treating COPD patients for anxiety using CBT reduces hospital visits and is cost-effective
23 November, 2018
Cognitive behavioural therapy (CBT) delivered by respiratory nurses is cost-effective and reduces anxiety symptoms in chronic obstructive pulmonary disease (COPD) patients, according to research published in ERJ Open Research.
The researchers aimed to test whether one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety caused by breathlessness, and whether this could be a cost-effective intervention by reducing visits to the hospital.
A total of 236 patients with a diagnosis of mild to very severe COPD took part in the trial. At the start of the study, each patient was screened for anxiety using the HADS-Anxiety Subscale; those included in the study had score of eight or higher, indicating mild to severe anxiety.
Over a three-month period, patients were either given leaflets on anxiety management or given leaflets as well as CBT. The CBT sessions coached patients on how to develop coping strategies to deal with the anxiety caused by breathlessness, to help to improve physical activity levels.
All patients also received standard medical care, including lung function testing, a medical review and appropriate drug treatments, and pulmonary rehabilitation if eligible.
After three months, patients completed the HADS-Anxiety questionnaire again to assess how the different treatment methods affected their levels of anxiety.
The researchers found that CBT was more effective in reducing anxiety symptoms in COPD patients compared to leaflets alone; on average, the HADS-Anxiety scale scores of CBT patients improved by 3.4, while patients in the leaflet group improved by just 1.9.
After checking the hospital attendance records of patients in the study, the researchers found that for each patient who attended CBT, there was an average saving of £1,089 for hospital admissions and £63 for emergency room attendances.
The data also showed no link between a patients' lung function, measured by how much air a person can breathe out in one second, and their anxiety score. The researchers say this suggests that even patients with mild COPD can feel extremely anxious, and so would benefit from this intervention.
Dr Karen Heslop-Marshall, a Nurse Consultant at Newcastle-upon-Tyne NHS Foundation Trust and Newcastle University, UK, was lead researcher on the study. She explains: "We found that one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and that this could be a cost-effective intervention. Although the CBT intervention initially resulted in added costs, as respiratory nurses required training in CBT skills, this was balanced by the savings made thanks to less frequent need of hospital and A&E services.
"Reducing the levels of anxiety patients experience has a significant impact on their quality of life as well as their ability to keep physically active and may improve survival in the long-term. Our research shows that front-line respiratory staff can deliver this intervention efficiently and effectively."
The researchers say it was not possible to blind participants to what method of treatment they received, which may have had an impact on their responses to the second HADS questionnaire. They are also unable to determine which specific element of the CBT intervention was most effective at reducing feelings of anxiety.
Dr Thierry Troosters, from the Katholieke Universiteit Leuven, Belgium, is President-Elect of the European Respiratory Society and was not involved in the research. He said: "COPD is a major burden to individuals, societies and healthcare systems across the world. This is partly due to the continued exposure to risk factors for COPD, such as smoking and air pollution, and partly due to ageing populations.
"This research highlights how using a multidisciplinary approach in the treatment of COPD can reduce the burden on patients and healthcare services. Treating patients for co-existing conditions such as anxiety contributes greatly to improving their overall health, and these methods can be cost-effective. Care provided by dedicated and properly trained healthcare professionals also allows for early referral of patients with more serious mental health conditions to even more specialised care tracks."