Impacts of Coil Treatment on Anxiety and Depression in Emphysema.

Chronic obstructive pulmonary disease (COPD) is a widespread, preventable, and treatable disease. Emphysema is one of the primary components of COPD and manifests itself via decrease in elastic recoil, hyperinflation, and increase in air trapping. Various lung-volume-reduction treatments have come up in recent years for late-stage emphysema patients. Mental disorders and especially anxiety and depression are among the frequently encountered comorbid cases observed in COPD. The aim of our study was to examine the impact of coil treatment applied for late-stage COPD-emphysema diagnosed patients on the accompanying anxiety and depressive symptoms. A total of 21 patients diagnosed with emphysema that meet the suitability criteria for coil treatment were included in the study. The accompanying anxiety and depressive symptoms of the patients were assessed via beck anxiety inventory (BAI) and beck depression inventories (BDI-I) prior to the procedure and one month later. All patients were male with an age average of 66.5 ± 5.5 (57-76). Among patients without a psychiatric diagnosis, BAI scores before and after coil treatment were determined, respectively, as 12.1 ± 6.3 (4-26) and 11.2 ± 9.3 (0-28), whereas BDI-I scores before and after coil treatment were determined, respectively, as 13.5 ± 10.4 (1-31) and 8.8 ± 10.6 (0-34), with a statistically significant difference between them. Also among patients with a psychiatric diagnosis, both anxiety and depressive symptoms decreased after coil treatment, and this reduction was found more significant for anxiety. Coil treatment as a current and novel treatment method for COPD-emphysema diagnosed patients with or without psychiatric comorbidity has a positive impact on anxiety and depressive symptoms.

Quantifying patient centered outcomes associated with the use of bilateral endobronchial coil treatment in patients with severe emphysema.

OBJECTIVE: To determine the impact of endobronchial coils on health-related quality-of-life (HRQoL). This paper utilizes trial data to identify the predictors of HRQoL in patients with severe emphysema, and subsequently estimates the impact of a new treatment on HRQoL (measured by utilities). These utility estimates are used to generate indicative long-term QALY estimates for a range of clinically plausible scenarios as a precursor to cost-effectiveness analyses. METHODS: Patient level HRQoL data from RENEW and the National Emphysema Treatment Trial (NETT) were combined and mapped to generic EuroQol 5-dimension health utility questionnaire (EQ-5D) values using a published algorithm. Multilevel statistical models were developed using treatment, time, response, and baseline characteristics (EQ-5D, age, gender, FEV1, lung RV) to predict EQ-5D over time. Lifetime QALY estimates were generated using published survival data from NETT (assuming no impact of treatment on mortality) and four clinically plausible response profiles. Each response profile was combined with assumptions around treatment impact (constant or time varying). RESULTS: After controlling for baseline characteristics, both treatment and response had a statistically significant impact (p < .001) on utility (+0.101 and +0.061, respectively). When combined with selected baseline characteristics and time, Coils and Standard of Care (SoC) generated more QALYs than SoC alone in all scenarios, with incremental lifetime benefit ranging from 0.29-0.55 QALYs. CONCLUSIONS: Coils and SoC resulted in statistically significant improvements in HRQoL compared to SoC alone in patients with severe emphysema.

Improved neurobehavioral functioning in emphysema patients following lung volume reduction surgery compared with medical therapy.

STUDY OBJECTIVES: The goal of this study was to evaluate the neuropsychological and psychological functioning of emphysema patients following lung volume reduction surgery (LVRS) compared with patients receiving only medical therapy (MT). DESIGN: Patients with moderate-to-severe emphysema who were enrolled in the National Emphysema Treatment Trial at two sites (National Jewish Medical and Research Center and Ohio State University) were given a neuropsychological battery at baseline, 6 to 10 weeks later (following participation in pulmonary rehabilitation), and at 6 months following randomization to either LVRS or MT treatment. SUBJECTS AND MEASUREMENTS: Twenty patients randomized to MT, 19 patients randomized to LVRS, and 39 matched, healthy control subjects completed a battery of tests that measured cognitive functioning, depression, anxiety, and quality of life (QoL). RESULTS: Controlling for practice, patients in the LVRS treatment arm at the 6-month follow-up demonstrated significant improvement compared with MT patients in cognitive tasks involving sequential skills and verbal memory. The LVRS patients also showed significant reductions in depression compared with the MT patients, as well as improved physical and psychosocial QoL. Correlational analysis indicated that improved immediate verbal memory in the LVRS group was related to improved QoL. No associations were found between changes in cognitive function and changes in depression, exercise performance, or pulmonary functioning. CONCLUSION: Patients who received LVRS demonstrated improvement in specific neuropsychological functions, depression, anxiety, and QoL scores compared with patients with continued MT treatment 6 months following randomization. However, mechanisms for these neurobehavioral changes are unclear. Improved verbal memory and sequential skills following LVRS were not directly associated with depression or exercise capacity. Nonetheless, LVRS led to a strong and likely clinically significant improvement in neuropsychological functioning over and above that explained by practice effects or MT. This finding adds to the growing list of clinical benefits of LVRS over MT, and supports additional research into the underlying mechanisms of this therapeutic effect.

Lung volume reduction surgery: a new breath of life for emphysema patients.

Patients with emphysema suffer continuously with dyspnea which ultimately can affect their activities of daily living. Lung volume reduction is a surgical procedure that is effective in relieving the dyspnea and improving the patient's quality of life.