Systematic meta-analysis of pharmacological and psychological interventions for the treatment of anxiety in patients with chronic obstructive pulmonary disease
Rates of anxiety symptoms in patients with COPD range from 13% to 51%, which is higher than rates for patients with other chronic diseases, yet evidence underpinning the effectiveness of the various treatment options is lacking. The aim of this review was to assess the efficacy and safety of both pharmacological and psychological interventions for the management of anxiety in COPD.
We searched two Cochrane Specialised Registers of Cochrane Airways group and Cochrane Collaboration of Depression, Anxiety and Neurosis with complementary screening of Medline, PsycINFO and CENTRAL. Reference lists of included studies and online clinical trial registries were also explored. Randomised controlled trials (RCTs) and cross-over studies of pharmacological or psychological interventions for patients (age >40 years) with diagnosed COPD and co-existing anxiety (confirmed by recognised diagnostic criteria or validated measurement scale) were identified for inclusion. Data was extracted by two independent review authors with meta-analyses of outcomes performed using the random-effect model using Review Manager Version 5.3.
A total of 1,792 citations resulted in nine included studies (five pharmacological and four psychological). Meta-analysis of these studies revealed significant reductions in anxiety symptoms, both with and without adjusting for heterogeneity, in the treatment arm (mean difference -2.84; 95%CI - 4.42 to -1.26; p=0.0004, standardised mean difference -0.44; 95% CI -0.74 to -0.14; p=0.004) with the psychological studies producing greater treatment efficacy (p=0.005 for MD and p=0.02 for SMD) over pharmacological (p=0.10 for MD and p=0.20 for SMD) within sub-group analysis. Significant improvement in depression scores was noted (p=0.03), mainly driven by psychological interventions. A trend in favour of the intervention was found for the physical composite of quality of life measured by St George’s Respiratory Questionnaire (standardised mean difference -0.36; 95%CI -0.74 to 0.02; p=0.06; 3 studies), but not for other measures of quality of life. No evidence of any effect was found for exercise capacity or FEV1. Psychological therapies appear to be more effective than pharmacological interventions, which have little or no effect to reduce anxiety in COPD patients. However, poor methodological quality and small sample size of studies investigating pharmacotherapy may be contributing to this discrepancy.