Disease-specific fears and health status during pulmonary rehabilitation in patients with COPD

Anxiety and depression are prevalent in patients with COPD and negatively impact pulmonary rehabilitation (PR) outcomes, including health status. More recently, disease-specific fears have been put forward as an important predictor of health status in COPD, but their role in PR contexts remains poorly understood. Therefore, we tested how different disease-specific fears in patients with COPD evolve over the course of PR and how these fears relate to health status.

Patients with COPD (n = 146) participated in a 3-week inpatient multidisciplinary PR program. At baseline, after PR and at 6-months follow-up, disease-specific fears were assessed with the COPD-Anxiety-Questionnaire (CAF), which includes the subscales fear of dyspnea, fear of physical activity, fear of disease progression, fear of social exclusion and sleep-related worries. Subjective health status and depressive symptoms were assessed with the COPD Assessment Test (CAT) and the Patient Health Questionnaire-9, respectively.

After PR, all disease-specific fears were significantly reduced. For fear of dyspnea, fear of physical activity and fear of disease progression, this improvement was maintained at follow-up. After PR, significant improvements in CAT scores were observed, which were partially maintained at follow-up. Baseline levels of disease-specific fears predicted CAT scores at baseline, with patients with higher CAF-subscale scores (1 SD above mean) showing CAT scores that were 2.5 (fear of disease progression) to 3.8 (sleep-related worries) points higher than in patients with average levels of CAF-subscale scores. The effects of baseline CAF scores on CAT scores were maintained after PR and at follow-up. Controlling for potential confounding variables (sex, smoking status, age, FEV1%predicted and depressive symptoms) resulted in comparable effects in all analyses.

The present findings demonstrate that disease-specific fears improve during PR. However, increased baseline levels of disease-specific fears continue to have a negative impact on health status after PR and at 6-months follow-up. This suggests that PR programs should include diagnosing and targeting of disease-specific fears to further improve the beneficial effects of PR on health status in patients with COPD.