Pulmonary Rehabilitation and Psychological Support

3. Improvement of Functional Capacity, and Quality of Life

3.1 Pulmonary Rehabilitation (PR)

This is an integral part of COPD management. Among various benefits, PR increases exercise capacity, improves health-related quality of life (HRQoL), and reduces breathlessness. We will discuss PR in detail in week 5 of this course.

3.2 Psychological Support

• Breathlessness is the predominant symptom in COPD, and primary care faces challenges of its management. Over 80% of COPD patients experience some degree of breathlessness. Relieving breathlessness is a challenge for primary care management.
• Breathlessness is a debilitating symptom, with a negative impact on quality of life, psychological wellbeing and functional status leading to distress, social isolation and a sense of helplessness that can be devastating.
• In stable COPD, the prevalence of clinical depression varies from 10% to 57% and anxiety ranges between 7% and 50%.
• Depression and anxiety are often under-recognised and under-treated in COPD patients. This can have major implications for compliance with medical treatment, increased frequency of hospital admissions, prolonged stay, poor quality of life and premature death.

The Breathing, Thinking, Functioning Clinical Model

(Image taken from the following paper licensed under CC BY 4.0)

Among a variety of psychological interventions, cognitive behavioural therapy (CBT), relaxation techniques and mindfulness have proven useful in breaking the ‘vicious cycle’, and promoting a ‘cycle of improvement’.

Breathing, Thinking, Functioning Clinical Model

Note: handheld fans are not advised during COVID in a communal setting (ward, waiting room or residential home) and where there are other people. Please seek advice for use of handheld fans in the home.

You can read more about the model that helps show the three interconnected issues of breathlessness in The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.

You can also read a shorter piece written for the UK group by the same author, Managing Breathlessness: the Breathing, Thinking Functioning approach.