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Original Research: COPD |

The Development and Validation of the Anxiety Inventory for Respiratory DiseaseAnxiety Inventory for Respiratory Disease

Thomas G. Willgoss, PhD; Juliet Goldbart, PhD; Francis Fatoye, PhD; Abebaw M. Yohannes, PhD
Author and Funding Information

From the Department of Health Professions (Drs Willgoss, Goldbart, Fatoye, and Yohannes), Manchester Metropolitan University, Manchester, England.

Correspondence to: Abebaw M. Yohannes, PhD, Department of Health Professions, Manchester Metropolitan University, Hathersage Rd, Manchester, M13 0JA, England; e-mail: A.yohannes@mmu.ac.uk


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. See online for more details.


Chest. 2013;144(5):1587-1596. doi:10.1378/chest.13-0168
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Background:  Anxiety is a common comorbidity in patients with COPD, yet it remains underrecognized. Existing anxiety measures contain somatic items that can overlap with symptoms of COPD and side effects of medications. There is a need for a disease-specific nonsomatic anxiety scale to screen and measure anxiety in patients with COPD.

Methods:  In phase 1, 88 patients with COPD (mean age 71 years, 36% men) completed a 16-item scale developed with patients and clinicians. Six items were removed using item and factor analysis. In phase 2, 56 patients with COPD (mean age 70 years, 48% men) completed the 10-item scale and other self-report measures of anxiety, quality of life, and functional limitations. Of these, 41 patients completed the scale on a second occasion, 14 days later. Construct validity (using confirmatory factor analysis [CFA]), discriminant validity, convergent validity, and anxiety screening accuracy were explored.

Results:  The Anxiety Inventory for Respiratory Disease (AIR) had high internal consistency (Cronbach α = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.81) and excellent convergent validity, correlating with the Hospital Anxiety and Depression-Anxiety subscale (r = 0.91, P < .001). The scale also discriminated between patients with clinical anxiety (measured using the Patient Health Questionnaire) and those without (U = 9, P < .001). A cutoff score of 14.5 yielded a sensitivity of 0.93 and specificity of 0.98 for detection of clinical anxiety. A two-factor model of general anxiety and panic symptoms had the best fit according to CFA.

Conclusions:  The AIR is a short, user-friendly, reliable, and valid scale for measuring and screening anxiety in patients with COPD.

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