Lebensqualität bei chronisch-obstruktiver Lungenerkrankung (COPD): Aspekte und Einflussmöglichkeiten

In the context of chronic obstructive pulmonary disease (COPD), treatment does not only aim at reducing symptoms and prolonging life expectancy, but also at promoting quality of life. COPD is characterized by a progressive and not-reversible obstruction of airway passages, and quality of life is substantially impaired across all stages of the disease. Previous studies showed a merely small relationship between lung function parameters and quality of life, medical predictors cannot sufficiently predict quality of life. Psychological aspects such as anxiety and depression, disease-specific anxieties or self-efficacy seem to play an additional important role. This publication-based dissertation examined different aspects of quality of life in COPD and identified opportunities to influence it. Besides anxiety disorders in the sense of the international classification systems of mental disorders, further presentations of anxiety (for example disease-specific anxieties and end of life fears) play an important role in the context of chronic progressive physical diseases and may impair quality of life beyond physical symptoms. A first study confirmed the relevance of disease-specific anxieties and end of life fears in the context of COPD. End of life fears occurred independently from disease severity. Mental distress and disease-specific anxieties (fear of progression, fear of social isolation) predicted end of life fears. A second study investigated associations between coping with disease and two aspects of quality of life (physical and mental). Age, disease severity, active problem-focused coping, looking for information, readiness of accepting help and looking for social inclusion predicted physical quality of life, whereas active problem-focused coping, depressive coping and looking for social inclusion predicted mental quality of life. As patients suffering from COPD often live in a partnership, which may also be affected by the disease, dyadic coping is relevant in addition to individual coping with disease. Thus, a third study took dyadic coping as subject. Within a longitudinal design, dyadic coping was associated with both partners’ quality of life. Relevant dyadic coping aspects were stress communication, negative dyadic coping and delegated dyadic coping. Overall, these studies highlight the relevance of psychological concepts in maintaining quality of life in COPD. Interventions aiming at improving quality of life seem to be indicated across all stages of the disease. Potential approaches are discussed.