Sex differences and determinants of anxiety symptoms in patients with COPD initiating pulmonary rehabilitation

A M Yohannes; R Casaburi; S Dryden; N A Hanania

doi:10.1016/j.rmed.2024.107633

Sex differences and determinants of anxiety symptoms in patients with COPD initiating pulmonary rehabilitation

Respir Med. 2024 Jun:227:107633. doi: 10.1016/j.rmed.2024.107633. Epub 2024 Apr 15.

Authors

A M Yohannes¹, R Casaburi², S Dryden³, N A Hanania⁴

Affiliations

¹ Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: amyohann@uab.edu.
² Respiratory Research Institute, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.
³ St. Annes Primary Care Center, Lytham, Lancashire, United Kingdom.
⁴ Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, USA.

PMID: 38631527
DOI: 10.1016/j.rmed.2024.107633

Abstract

Background: Anxiety is common in patients with chronic obstructive pulmonary disease (COPD). However, there is little evidence available regarding gender differences, and severity of dyspnea in relation to anxiety in patients with COPD.

Aims: We examined gender differences and the association of dyspnea with anxiety in a cohort of patients with COPD prior to entering a pulmonary rehabilitation (PR) program.

Method: We analyzed data from a prospective cohort of COPD patients who attended PR from 2013 to 2019 in Lytham, Lancashire, UK. Patients were aged 40 years or older with a post-bronchodilation forced expiratory volume in 1 s (FEV₁) less than 80 % of the predicted normal value and FEV₁/FVC (forced vital capacity) ratio less than 0.7. We assessed quality of life (QoL) using the Saint George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT).

Results: Nine hundred ninety-three patients with COPD (mean age = 71 years, FEV₁/FVC = 58 % predicted, 51 % male) entered the PR program. Of these, 348 (35 %) had anxiety symptoms (AIR ≥8); of these 165 (47 %) were male and 183 (53 %) female, (χ² = 3.33, p = 0.06). On logistic multivariate analysis, the following variables were independently associated with elevated anxiety: younger age (p < 0.001), female sex (p = 0.03), higher SGRQ-total score (p < 0.001) and high FEV₁/FVC (p < 0.002). Dyspnea was associated with anxiety r = 0.25, p < 0.001.

Conclusion: Over a third of COPD patients had clinically relevant anxiety symptoms with a higher prevalence in women than men. Anxiety was associated with younger age, female gender, and impaired QoL. Early recognition and treatment of anxiety in patients with COPD is worthy of consideration for those attending PR, especially women.

Keywords: Anxiety; COPD; Dyspnea; Female gender; Pulmonary rehabilitation.

MeSH terms

Aged
Anxiety* / psychology
Dyspnea* / etiology
Dyspnea* / physiopathology
Dyspnea* / psychology
Exercise Tolerance / physiology
Female
Forced Expiratory Volume / physiology
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / physiopathology
Pulmonary Disease, Chronic Obstructive* / psychology
Pulmonary Disease, Chronic Obstructive* / rehabilitation
Quality of Life*
Severity of Illness Index
Sex Factors
Surveys and Questionnaires
Vital Capacity / physiology