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Original Research: COPD |

Dyspnea Perception in COPDDyspnea-Related Fear in Pulmonary Rehabilitation: Association Between Anxiety, Dyspnea-Related Fear, and Dyspnea in a Pulmonary Rehabilitation Program

Thomas Janssens, MA; Steven De Peuter, PhD; Linda Stans, MA; Geert Verleden, MD, PhD; Thierry Troosters, PhD; Marc Decramer, MD, PhD; Omer Van den Bergh, PhD
Author and Funding Information

From the Research Group Health Psychology (Mr Janssens and Drs De Peuter and Van den Bergh), Department of Psychology; the Pneumology Department (Ms Stans and Drs Verleden, Troosters, and Decramer); and the Faculty of Kinesiology and Rehabilitation Sciences (Dr Troosters), University of Leuven, Leuven, Belgium.

Correspondence to: Omer Van den Bergh, PhD, Research Group on Health Psychology, Department of Psychology, Tiensestraat 102, B-3000, Leuven, Belgium; e-mail: omer.vandenbergh@psy.kuleuven.be


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):618-625. doi:10.1378/chest.10-3257
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Background:  A growing body of research connects anxiety with poorer outcomes in COPD. However, more specific measures of dyspnea-related fear may be more closely related to critical processes involved in pulmonary rehabilitation (perception of dyspnea and avoidance of physical activity) and may have a predictive value for COPD outcome beyond general anxiety measures.

Methods:  In this naturalistic outcome study, we investigated the effects of baseline anxiety and dyspnea-related fear on perceived dyspnea and other outcomes of a well-established pulmonary rehabilitation program for COPD.

Results:  Seventy-three patients participated in the study. At baseline, higher dyspnea-related fear was associated with higher levels of dyspnea during ergometer exercise, but also with a steeper decrease of exercise dyspnea during the course of pulmonary rehabilitation, whereas lower dyspnea-related fear was associated with an increase in exercise dyspnea, even when controlling for anxiety, lung function, and exercise intensity. Furthermore, higher dyspnea-related fear was associated with reduced quality of life (mastery subscale) and maximal exercise capacity at baseline, but also with a steeper increase in quality of life (emotions and mastery subscale) and exercise capacity during rehabilitation. However, the association of dyspnea-related fear with worse 6-min walking distance and impairment in daily activities persisted throughout rehabilitation.

Conclusions:  Results indicate a mediating effect of dyspnea-related fear on the association between anxiety and exercise-related dyspnea. Exercise in pulmonary rehabilitation in people with higher baseline dyspnea-related fear may act as a correction of excessive symptom reports through exposure to dyspneic situations.

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