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Cited by 50Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesSmoking Behavior and Cessation

‘The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease

Open access
Howard, Claire, Dupont, Simon·2014·npj Primary Care Respiratory Medicine
DOI 10.1038/npjpcrm.2014.76PMC PMC4373470
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Abstract

Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant. The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care. A cognitive-behavioural manual that helps patients manage their breathlessness significantly reduces visits to emergency departments. Up to 60% of patients with chronic obstructive pulmonary disease (COPD) also suffer from anxiety, panic and depression due to their shortness of breath. To assess the effect of a cognitive-behavioural therapy approach on health service use and the mental health of patients with COPD, Claire Howard at The Hillingdon Hospital in Uxbridge, UK, and colleague Simon Dupont, randomly allocated either information booklets about the disease or The COPD Breathlessness Manual (CM) to over 200 patients. The manual was developed by psychologists to help patients self-manage their condition. After 12 months, the researchers found a reduction in anxiety and depression in the CM group and a significant drop in visits to emergency departments, indicating that the manual represents a cost-effective intervention.

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  • The most successful interventions for breathlessness are multi-modal, non-pharmacological approaches that work concurrently at multiple points within the brain, respiratory and skeletal system.

    “Instead the most successful interventions appear to be multi-modal, non-pharmacological approaches that work concurrently at multiple points within the brain, respiratory and skeletal system.”

    From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [21]

    The Materials and methods section describes a non-pharmacological manual combining cognitive-behavioural strategies, breathing control and mobility exercises. But the Discussion says the study cannot identify which component was most effective and calls for trials disentangling their contributions. It does not establish that multimodal approaches are the most successful or that they act concurrently within the brain, respiratory and skeletal systems. Our copy provides section labels but no page numbers. (LLM, conf=0.88)

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  • Approaches incorporating cognitive behavioural therapy ameliorate breathlessness, anxiety and depression.

    “Approaches incorporating cognitive behavioural therapy ameliorate breathlessness, as well as anxiety and depression.”

    From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [21]

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Research works printed but not linked: 3

  1. Usmani ZA Cheng NJ Smith BJ Carson KV A meta-analysis (Cochrane review) of pharmacological and psychological interventions for anxiety and depression in COPD Respirology 2010 15 1323 7799
  2. Ramsenthaler C Siegert RJ Weatherall M Bausewein C Koffman J Higginson IJ Cognitive behavioural therapy (CBT) for panic and anxiety in chronic obstructive pulmonary disease—a systematic review Palliat Med 2012 26 0269 2163
  3. Ramsenthaler C Siegert RJ Weatherall M Bausewein C Koffman J Higginson IJ Cognitive behavioural therapy (CBT) for panic and anxiety in chronic obstructive pulmonary disease—a systematic review Pall Med 2012 26 405 406

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Authors
Howard, C., & Dupont, S.
Affiliations
Central and North West London NHS Foundation Trust (GB)
Corresponding author
Howard, Claire
ORCID
Dupont, Simon
Venue
npj Primary Care Respiratory Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-10-16
Volume
24
Issue
1
Pages
14076-14076
ISSN
2055-1010 (ISSN-L)
DOI
10.1038/npjpcrm.2014.76
PMC
PMC4373470
OpenAlex
W2094009467
Cited by
50
References
37
Citations by year
2025: 2 · 2024: 1 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 7 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 3 · 2015: 2
FWCI
3.21
Type
journal article
Language
en
Open access
Licence
Locations
  • npj Primary Care Respiratory Medicine (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
chronic obstructive pulmonary disease, dyspnea, cognitive behavioral therapy, self-management, information booklet, health care utilization, emergency department visits, hospitalization, anxiety, depression, cost-effectiveness, primary care intervention, telephone follow-up, patient education, health status, mood, health-related quality of life
MeSH terms
Affect, Aged, Dyspnea, Female, Health Status, Humans, Male, Pamphlets, Patient Education as Topic, Prospective Studies, Cognitive Behavioral Therapy, Single-Blind Method, Pulmonary Disease, Chronic Obstructive

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