Anxiety, Panic, and Loss of Control in COPD

Anxiety and Chronic Obstructive Pulmonary Disease

Anxiety is common in patients with chronic obstructive pulmonary disease (COPD). As many as half of all patients with COPD have a clinical anxiety disorder. Anxiety is particularly severe during acute exacerbations and breathlessness. However, patients with COPD are known to experience anxiety at other times, and little is known about the emotions, triggers, impact, or management of anxiety in patients with stable COPD living in the community. The purpose of this study was to explore and describe these experiences.

Study Summary

This small qualitative study interviewed 14 patients (9 women and 5 men) recruited from pulmonary rehabilitation and community supports groups in England. Patients completed an anxiety and depression scale to determine the severity of their symptoms.
On the basis of anxiety and depression scale scores, 5 patients had clinically significant symptoms of depression, 6 had clinically significant anxiety symptoms, and 4 had both. Five of the patients with anxiety had a past clinical diagnosis of generalized anxiety disorder, for which 4 had been treated, although all had discontinued their treatment. The analysis found 3 global themes:

• Relationships with breathing -- anxiety was described as both a symptom and a cause of breathlessness. Although breathlessness was a trigger for both anxiety and panic for some patients, for others, episodes were idiopathic and could be trigged by many situations, such as social discomfort and misplacing medications. The relationship between anxiety and breathing was experienced as a vicious cycle by some patients. Living with anxiety was challenging, and patients voiced a fear of breathlessness that could be disabling.
• Fighting for control -- anxiety was a fight for control and associated with panic and helplessness at times. The process of taking control was described as logical and systematic, with self-talk an important and critical strategy. The battle for control was vital in preventing panic episodes. Medication was seen as an important component of controlling COPD, so having medication available was seen as controllable and integral.
• Panic attacks as life changing -- panic attacks were described as traumatic and isolating. Patients felt trapped or smothered, with some describing panic as "near-death experiences." These episodes had a lasting effect and resulted in a persistent fear of recurrence with some describing "meta-worry" (worry about worry) that sometimes led to future attacks. Fear of anxiety caused some patients to become housebound.

Viewpoint

This study, like many studies in the nursing literature, is limited by its very small and nonrandom sample. It is impossible to extrapolate the experiences of these patients to the larger population of all COPD patients. However, these researchers describe an important methodology for exploring a critical component of a very common chronic disease. Clearly more research is needed, particularly in defining the self-management skills described by some patients as important in controlling anxiety and preventing panic attacks. This information could lead to patient education strategies that will assist clinicians in teaching patients these important skills and improving the quality of life for a large segment of this population.