Agoraphobic avoidance predicts emotional distress and increased physical concerns in chronic obstructive pulmonary disease

- The clinical relevance of this paper lies, in our view, first of all in evidencing the prevalence, associations and clinical significance of agoraphobic avoidance in COPD individuals, the issue that has been hardly studied.
- We found that avoidance level predicted emotional distress and physical concerns in COPD individuals while dyspnea level, pulmonary dysfunction and current panic attacks did not.
- The results call for including agoraphobic avoidance into the diagnostic procedures, management and treatment protocol for COPD.

BackgroundAnxiety and panic attacks are more common in chronic obstructive pulmonary disease (COPD) than in the overall population. Individuals with panic attacks often attempt to avoid situations perceived as at risk of eliciting bodily sensations such as dyspnea, which paradoxically may lead to anxiety-related responsivity. Although there is some evidence that COPD individuals restrict their participation in various life activities because they fear that these may trigger breathlessness, little is known about agoraphobic avoidance and its impact on cognitions and emotional distress in this population. It was thus our aim to investigate the degree of agoraphobic avoidance in COPD individuals, its clinical concomitants and consequences.MethodsA total of 48 patients with COPD and 48 matched controlled subjects completed measures of anxiety sensitivity, agoraphobic avoidance, anxiety and depression. Objective COPD severity was measured using forced expiratory volume in the first second.ResultsPatients showed significant impairment in respiratory functioning and psychological distress. Relative to the control, the COPD group exhibited greater depression, anxiety, physical symptom concerns and avoidance (alone and accompanied), irrespective of whether they were panickers or not. Patients with high avoidance showed more intense physical concerns when compared to those with low avoidance. Importantly, the level of avoidance predicted emotional distress and increased physical concerns in COPD.ConclusionsPhysical concerns scores in COPD patients are partially explained by avoidance in this group. The results of the study provide evidence for the importance of evaluating avoidance in COPD patients and implicate targeting this behavior in therapeutic interventions.