Der Einfluss psychischer Faktoren auf die Bewältigung der chronisch obstruktiven Lungenerkrankung (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. COPD is progressive and characterised by dyspnea, cough and sputum production. The somatic symptoms cause a significant disability for people with COPD that goes along with reduced quality of life and increased comorbid psychological symptoms such as disease-specific fears or psychological disorders. Complete symptom reduction cannot be achieved by medical treatment. Therefore, treatment should sustain the quality of life. Thus, aim of this dissertation was to examine psychological factors and their relationship to health-related quality of life that are either disadvantageous (e.g. disease-specific fears) or advantageous (protective factors) for coping with COPD. In a cross-sectional study we investigated the hypothesis that disease-specific fears contribute to health-related quality of life (study 1). For the better assessment of those COPD-specific fears we further developed a psychometric instrument with the help of a large sample of people suffering from COPD. As expected, we found that more disease-specific fears were associated with less health-related quality of life. This was found in a regression analysis after controlling for symptoms of general anxiety and depression, stage of disease, age and gender. With increasing disease severity people with COPD reported more disease-specific fears and less health-related quality of life. In another cross-sectional study we explored the impact of possible psychological protective factors on health-related quality of life and comorbid symptoms of anxiety and depression (study 2). Two concepts were investigated that represent some sort of process of inner growth and aim at assessing personality characteristics which promote adaptation to stressors or life events: Sense of coherence and resilience. Regression analyses showed that more sense of coherence and resilience go along with more health-related quality of life and less symptoms of anxiety and depression. Disease severity predicted health-related quality of life negatively and was associated with more symptoms of depression, but not symptoms of anxiety. In a review we explored different psychological factors found to be relevant in the treatment of COPD within a pulmonary rehabilitation regarding coping with disease (study 3). In summary, we found that these factors contributed to the variance in treatment outcomes between patients. Since pulmonary rehabilitation is a core treatment option in COPD, these factors impact coping and therefore health-related quality of life. The studies that have been carried out emphasize the importance of psychological factors regarding coping, since they yielded relationships between disease-specific fears, protective factors and other psychological factors and health-related quality of life. It is discussed how these findings should be appraised, how research approaches can be developed further and which treatment options can be deduced.