Remote pulmonary rehabilitation improves depression, quality of life related to COPD

Key takeaways:

• Fewer depression symptoms were found in those with COPD after receiving pulmonary rehab at home vs. usual care.
• Quality of life related to the disease also improved with remote rehab.

WASHINGTON — In patients with COPD, pulmonary rehabilitation conducted remotely led to improvements in depression and quality of life, according to an abstract presented at the American Thoracic Society International Conference.

“Depression affects between 26% to 40% of COPD patients,” Roberto P. Benzo, MD, MS, founding director of the Mindful Breathing Laboratory in the division of pulmonary, critical care and sleep medicine at Mayo Clinic in Rochester, Minnesota, and colleagues wrote.

“Non-pharmacological treatments that have been shown to address depression in these patients are pulmonary rehabilitation (PR), cognitive-behavioral therapy, coping skills training and mindfulness approaches,” Benzo and colleagues added. “However, they all have poor uptake or are difficult to implement in daily practice.”

In a sub study of a randomized control trial, Benzo and colleagues analyzed 168 adults with COPD and symptoms of depression to find out if a PR program with health coaching designed to be conducted at home for 12 weeks improves depressive symptoms.

Adults included had a score greater than 5 points on Patient Health Questionnaire-9 (PHQ-9), which was used to evaluate symptoms of depression at baseline and 12 weeks. Researchers also assessed patients’ quality of life related to COPD with the Chronic Respiratory Questionnaire (CRQ).

Of the total cohort, 90 patients received the home-based rehabilitation program that featured health coaching through the form of video-guided mindfulness-based movement practice, which patients’ accessed on a tablet. This program also featured remote monitoring of patients using their daily steps, symptoms and exercise adherence. The remaining patients received usual care.

From baseline to 3 months, researchers observed more improvement in depression symptoms in those receiving the at-home program than those receiving usual care (mean change in PHQ-9 score, –2.53; 95% CI, –3.39 to –1.67 vs. –1.13; 95% CI, –2.05 to –0.21).

Further, patients receiving at-home rehab showed more improvement in measures of the quality of life related to COPD on the CRQ compared with patients receiving standard care. The greatest between group difference at 3 months was found in mastery/self-management (mean, 0.8; 95% CI, 0.43-1.18), followed by emotions (mean, 0.65; 95% CI, 0.35-0.95), dyspnea (mean, 0.6; 95% CI, 0.28-0.93) and fatigue (mean, 0.59; 95% CI, 0.28-0.9; P < .001 for all).

“Our results represent a new approach to the treatment of depression in COPD,” Benzo and colleagues wrote. “The home-based nature, the personalized approach to behavior change, and the target of awareness (mindfulness) may represent key factors for the effect found.”