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(1) Background: Most controlled trials of cognitive behavior therapy (CBT) in people living with chronic obstructive pulmonary disease (COPD) have targeted anxiety and depression. (2) Methods: This pragmatic randomized controlled trial explored whether a comprehensive pulmonary rehabilitation program (CPRP) with CBT for breathlessness or social group control (CPRP + SC) significantly improved health outcomes. (3) Results: People with moderate-to-severe COPD were block randomized (CPRP + CBT n = 52 or CPRP + SC n = 49). Primary outcomes (Hospital Anxiety and Depression scale (HADs), six-minute walk distance (6MWD)) and secondary outcomes (breathlessness, quality of life and habitual physical activity) were assessed before and 1, 6 and 12 months post intervention. Between-group differences were calculated with mixed models for each time point to baseline (intention to treat (ITT)). Participants (n = 101, mean ± SD age 70 ± 8.5 years, 54 (53%) males, FEV1% pred 47.7 ± 16.3) were similar between groups. Post intervention, primary outcomes did not differ significantly between groups at 1 (6MWD mean difference −7.5 [95% CI −34.3 to 19.4], HADs-A −0.3 [−1.4 to 0.9], HADs-D 0.2 [−0.8 to 1.3]), 6 (6MWD −11.5 [−38.1 to 15.1], HADs-A 1.1 [0.0 to 2.2], HADs-D 0.2 [−0.9 to 1.3]), or 12 months (6MWD −3.8 [−27.2 to 19.6], HADS-A −0.4 [−1.5 to 0.6], HADs-D −0.7 [−1.7 to 0.4]). (4) Conclusions: In this cohort, combining CBT with a CPRP did not provide additional health benefits beyond those achieved by a standard CPRP. [ABSTRACT FROM AUTHOR]

BACKGROUND: In patients with COPD, psychological interventions usually target generalized anxiety and depression rather than the sensation of breathlessness. The objectives of this pilot study were to develop and implement a cognitive behavioral therapy (CBT) program specific to the perceptual experience of breathlessness, identify practical issues in the study protocol, and estimate beneficial effects of combining the CBT program with comprehensive pulmonary rehabilitation. METHODS: The CBT program for the sensation of breathlessness (Breathing: Recognize sensations, Explore thoughts and beliefs, Validate thoughts as useful or harmful, Evolve and change behavior [BREVE]) was developed as a sequential series of 8 modules enabling it to be embedded within an 8-week comprehensive pulmonary rehabilitation program. When appropriate, outcomes from the pilot group (comprehensive pulmonary rehabilitation program + BREVE) were compared with those from a retrospective control group (comprehensive pulmonary rehabilitation program only). Outcomes included feedback provided by pilot study subjects, sensation of breathlessness (volunteered and endorsed descriptors of breathlessness), 6-min walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) total score. Within-group analyses were undertaken for descriptors of breathlessness (the McNemar test), whereas between-group analyses (repeated-measures analysis of variance, effect-size comparison) were conducted for the 6MWD and SGRQ total score. RESULTS: Pilot (n = 11) and control (n = 58) groups were not significantly different at baseline. Feedback indicated that the program structure and content were positively received. No significant changes were evident for the sensation of breathlessness or the SGRQ score (< 4 points). The 6MWD improved significantly in both groups, with the pilot group demonstrating greater gains compared with the control group (mean change of 57 m and effect size of 0.73 vs mean change of 27 m and effect size of 0.23; between groups, P = .03, effect size of 0.69). CONCLUSION: The CBT program for the perceptual experience of breathlessness was feasible and well accepted by subjects, although the protocol raised a number of methodological limitations warranting modification. A larger randomized controlled trial is needed to determine the effectiveness and longer-term outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study investigated whether descriptors of breathlessness differed after participation in an 8 week pulmonary rehabilitation program and whether changes in sensory quality would be reflected in responsiveness to pulmonary rehabilitation. METHODS: People with COPD provided descriptors for their sensation of breathlessness before and after an 8 week pulmonary rehabilitation program. Primary outcomes for responsiveness to pulmonary rehabilitation were the 6 minute walk distance (6MWD) and the St George Respiratory questionnaire. Significant proportional shifts for sensory categories after rehabilitation were identified using the McNemar test. Random effects mixed modeling was used to determine significance of differences for primary outcomes between subjects modifying or not modifying descriptors of breathlessness. RESULTS: Of the 107 people referred to the pulmonary rehabilitation program, 94 met the spirometric criteria for COPD, with 58 having data for pre and post assessments (36 males, 71 ± 9 years old, percent of predicted FEV1 58 ± 24%). A significant proportion of subjects reduced descriptors of air hunger (P = .03, odds ratio 0.31, 95% CI 0.09-0.89) and depressed, regret, helpless (P = .04, odds ratio 0.36, 95% CI 0.10 -1.05) following rehabilitation. Subjects reducing their use of descriptors of air hunger had greater improvements in the 6MWD after rehabilitation (P = .006, mean increase 46 m). CONCLUSIONS: The sensory quality of breathlessness was modified for approximately one third of subjects after pulmonary rehabilitation, with significant improvements in the 6MWD for subjects who reduced their use of descriptors of air hunger. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the association of breathlessness with the severity of impairment in airflow obstruction. The researchers used an observational and prospective approach to describe the sensation of breathlessness experienced by patients with chronic obstructive pulmonary disease (COPD). They found that affective descriptors of breathlessness sensation can lead to long-term behavioral changes.

Questions: Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness consistent? Design: Within-participant, repeated measures, experimental study. Participants: 57 people with symptomatic chronic respiratory disease aged 71 years. Intervention: There were three conditions. The first was recalled breathlessness. Two conditions of exercise-induced breathlessness were created by getting the participants to undertake the 6-min Walk Test twice (breathlessness 1 and 2). Outcome measures: Descriptors of breathlessness were volunteered (where participants' used their own words) or endorsed (from a pre-existing list of 15 breathlessness statements). Results: Emotive descriptors made up 65% of recalled descriptors compared with 11% of exercise-induced descriptors, whereas physical descriptors made up 35% of recalled descriptors compared with 89% of exercise-induced descriptors. Of the 237 potential language pairs volunteered to describe recalled and exercise-induced breathlessness 1, only 27 (11%) were identical whereas of the 171 potential language pairs endorsed as describing recalled and exercise-induced breathlessness 1, 66 (39%) were identical. Of the 175 potential language pairs of descriptors volunteered to describe exercise-induced breathlessness 1 and 2, 72 (41%) were identical whereas of the 153 potential language pairs endorsed as describing exercise-induced breathlessness 1 and 2, 71 (46%) were identical. Conclusion: The language used to describe exercise-induced breathlessness immediately after two walking challenges was similar. However, descriptions of recalled breathlessness did not consistently match descriptions of exercise-induced breathlessness, which may reflect the different contexts under which breathlessness was recalled and induced. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the language of breathlessness as differentiated between patients with chronic obstructive pulmonary disease and age-matched adults. It was undertaken uniformly for all subjects and was assessed at rest using a 10-cm visual analog scale for breathlessness intensity and dyspnea scale for any resperatory disability. The study results to clear differences in the quality, variety and frequency of the subjects as to their language of breathlessness.

Background and objectives: The fifteen-count breathlessness score (15CBS) has been reported to quantify breathlessness; however, a ceiling effect limits its ability to discriminate between subjects with varying degrees of breathlessness. The aim of this study was to determine the reliability, sensitivity, specificity and validity of the thirty-count breathlessness score (30CBS) in adults with COPD. Methods: Using an observational correlation design, subjects with clinical signs and symptoms of COPD were videotaped performing the 30CBS on two occasions. Respiratory related quality of life questionnaires, self-report shortness breathlessness measures and pulmonary function tests were completed by all subjects. Asymptomatic subjects of a similar age completed the 30CBS for comparison. Results: Thirty-eight COPD subjects and 24 control subjects completed the protocol. The 30CBS was reliable within and between assessors (intraclass correlation coefficients >0.7). The 30CBS demonstrated a higher sensitivity (55.8% sensitivity, 82.3% specificity) than the 15CBS (33.2% sensitivity, 93.2% specificity); however, the sensitivity of the 30CBS was still not great enough to discriminate between those with and without COPD. Regression analysis calculated significant relationships between the 30CBS and a majority of measures of pulmonary impairment (flows and volumes), age, height, Visual Analogue Scale for breathlessness and physical aspects of the Short Form-36. Conclusions: While reliable, the 30CBS did not display sufficient discriminative ability to predict subjects with COPD though subjects requiring greater than two breaths may warrant further investigation. The 30CBS may be a useful indicator of physiological impairment, but was not significantly correlated with measures of breathlessness. [ABSTRACT FROM AUTHOR]

Objective and background: The Fifteen-Count Breathlessness Score (15CBS) has been reported to quantify breathlessness. The aim of this study was to determine the reliability and validity of the 15CBS in adults with COPD. Methods: Using an observational correlation design, subjects with clinical signs and symptoms of COPD were videotaped performing the 15CBS at a self-selected (task 1) and an 8-s counting pace (task 2), on two occasions with 5-min rest between attempts. Respiratory-related quality of life questionnaires, self-report shortness of breath measures and pulmonary function tests were completed by all subjects. Results: Thirty subjects completed the protocol. No significant differences and good linear relationships were calculated for the 15CBS within subjects (task 1 P = 0.32, r = 0.75 and task 2 P = 1.00, r = 0.86) and between assessors (task 1 P = 0.57, r = 0.99 and task 2 P = 0.21, r = 0.75). No significant relationships were evident between the 15CBS and shortness of breath or quality of life scores. Significant relationships existed between the 15CBS and FVC (litres and per cent predicted). Conclusion: Most subjects completed the 15CBS using one breath, limiting discrimination between subjects with differing degrees of breathlessness. Although data from this study confirmed that the 15CBS is a reliable procedure within people with COPD, further modification is required to increase the validity and discriminative ability of this instrument. [ABSTRACT FROM AUTHOR]