RESUMO
Introduction Smoking cessation is the most effective approach to slowing down the progression of chronic obstructive pulmonary disease (COPD). Despite this, almost half of COPD patients continue to smoke after diagnosis. COPD patients with current smoking status are more likely to have concurrent psychiatric comorbidities, for instance, depression and anxiety. These psychiatric disorders can contribute to the persistence of smoking in individuals with COPD. This study aimed to investigate predictors of smoking persistence in COPD patients. Materials and methods A cross-sectional study was conducted in the Outpatient Department (OPD) of the Department of Pulmonary Medicine in a tertiary care hospital from August 2018 to July 2019. Patients with COPD were screened for their smoking status. All subjects were then personally assessed for any psychiatric comorbidity using the Mini International Neuropsychiatric Interview (MINI), the Patient Health Questionnaire-9 (PHQ-9), and the Anxiety Inventory for Respiratory (AIR) Disease. Logistic regression was performed to compute the odds ratio (OR). Results The study included a total of 87 COPD patients. Of the 87 COPD patients, 50 were current smokers, and 37 were past smokers. COPD patients with psychiatric disorders were four times more likely to continue smoking than those without psychiatric comorbidities (OR: 4.62, 95% CI: 1.46-14.54). The results showed that increasing PHQ-9 scores by one unit in COPD patients increased the likelihood of continuing to smoke by 27 percent. Conclusion In our multivariate analysis, current depression was found as a significant predictor of continued smoking in COPD patients. The present results are consistent with reports from previous research that depressive symptoms are associated with continued smoking in patients with COPD. COPD patients who are currently smoking should be examined for psychiatric disorders and treated concurrently to achieve effective smoking cessation.
RESUMO
Introduction Researchers have found that chronic obstructive pulmonary disease (COPD) patients suffer from anxiety more than the general population. The Anxiety Inventory for Respiratory Disease (AIR) scale has been primarily used to assess non-somatic anxiety in COPD patients. The validity of AIR among COPD patients has not been evaluated in Indian settings. Therefore, this study was undertaken to determine the validity of AIR in these patients. The study aimed to evaluate concurrent criterion and discriminative validity of the AIR screening scale among patients with COPD using Mini International Neuropsychiatric Interview (MINI) 7.0.2 as the gold standard measure for diagnosing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) anxiety disorders. Materials and methods A cross-sectional study was conducted in the Outpatients Department (OPD) of the Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, from August 2018 to July 2019. A total of 100 patients diagnosed with COPD and aged 30 or above were recruited. All participants were further assessed in person by a psychiatry resident doctor using semi-structured proforma, MINI 7.0.2, and AIR Disease (Hindi). Mann-Whitney U and receiver operating characteristic (ROC) curves were conducted. The two-sided p-value of less than 0.05 was considered to be statistically significant. Results To assess the concurrent criterion validity of the AIR scale for screening clinical anxiety disorders, the ROC curve was constructed using MINI diagnoses of anxiety disorder as the gold standard measure. A cut-off score of 5.5 was found to maximize both the specificity and sensitivity of the AIR scale for screening anxiety disorders among COPD patients with COPD. The AIR scale showed a high sensitivity (95%) and specificity (89%) at this cut-point. Conclusion The findings of this study recommend a cut-off score of 5.5 on the AIR scale instead of 8 in previous studies, as maintaining the previously recommended cut-offs in Indian settings may lead to an increase in false negatives. This could have negative consequences for patients seeking treatment. Further studies may be planned to explore the psychometric properties of the current tool in a larger population.